Occupation AtlasMidwives
O*NET · 29-9099.01
Midwives
Provide prenatal care and childbirth assistance.
12 more
Certified Professional Midwife (CPM) · CPM · Direct-Entry Midwife · Doula · Homebirth Midwife · Lay Midwife · Licensed and Certified Midwife · Licensed Certified Professional Midwife · Licensed Direct Entry Midwife · Licensed Midwife (LM) · LM · Postpartum Doula
Job Zone
- 1
- 2
- 3
- 4
- 5
Zone 5: Extensive Preparation Needed
Extensive preparation. Usually a graduate degree, with extensive skill, knowledge and experience — many of these occupations expect more than five years of experience.
Job Zone is O*NET's rating of how much education, experience and training an occupation typically needs — a property of the work, not of anyone doing it.
Occupational interest profile
SRISocial · Realistic · Investigative — the three strongest interests, in order
- S Social6.04
- R Realistic3.98
- I Investigative3.54
- C Conventional3.26
- E Enterprising2.70
- A Artistic1.91
RIASEC (Holland) interests on O*NET's 0–7 scale: what the work draws on, not what any individual prefers. Hover a row for what each dimension means.
Education and experience
The education level respondents say the job requires, and the most common answer for experience and training.
- Related work experience
- Over 2 years, up to and including 4 years (39%)
- On-site or in-plant training
- Over 1 month, up to and including 3 months (26%)
- On-the-job training
- Over 3 months, up to and including 6 months (38%)
Typically associated skills
All 35 O*NET skills, most important first. Importance (1–5) says how much a skill matters here; level (0–7) says how much of it the work calls for, with O*NET's example of a nearby level. Neither is a proficiency rating of a person.
- Social PerceptivenessImportance 4.1Level 4.9Level 4 looks like: Be aware of how a coworker's promotion will affect a work group
- MonitoringbasicImportance 4.0Level 4.6Level 4 looks like: Monitor a meeting and revise the agenda to ensure important topics are discussed
- Critical ThinkingbasicImportance 4.0Level 4.0Level 4 looks like: Evaluate customer complaints and determine appropriate responses
- Active ListeningbasicImportance 3.8Level 4.4Level 4 looks like: Answer inquiries regarding credit references
- Judgment and Decision MakingImportance 3.8Level 4.0Level 4 looks like: Evaluate a loan application for degree of risk
- SpeakingbasicImportance 3.8Level 4.0Level 4 looks like: Interview applicants to obtain personal and work history
- Service OrientationImportance 3.8Level 3.8Level 4 looks like: Make flight reservations for customers using an online booking site
- Reading ComprehensionbasicImportance 3.6Level 4.3Level 4 looks like: Understand an email from management describing new personnel policies
- CoordinationImportance 3.6Level 3.8Level 4 looks like: Work with others to put a new roof on a house
- Active LearningbasicImportance 3.4Level 3.6Level 4 looks like: Determine the impact of new menu changes on a restaurant's purchasing requirements
- Complex Problem SolvingImportance 3.4Level 3.3Level 4 looks like: Redesign a floor layout to take advantage of new manufacturing techniques
- InstructingImportance 3.3Level 3.5Level 4 looks like: Instruct a coworker in how to operate a software program
Show the other 23
- Learning StrategiesbasicImportance 3.3Level 3.4Level 4 looks like: Identify an alternative approach to help trainees who are having difficulties
- WritingbasicImportance 3.1Level 3.6Level 4 looks like: Write an email to staff outlining new directives
- PersuasionImportance 3.0Level 3.0Level 2 looks like: Solicit donations for a charity
- Systems EvaluationImportance 3.0Level 3.0Level 2 looks like: Determine why estimates for the time to complete a task are overly optimistic
- Time ManagementImportance 3.0Level 2.9Level 2 looks like: Keep a monthly calendar of appointments
- Systems AnalysisImportance 3.0Level 2.6Level 2 looks like: Determine how loss of a team member will affect the completion of a job
- SciencebasicImportance 2.9Level 2.9Level 2 looks like: Conduct standard tests to determine soil quality
- Management of Personnel ResourcesImportance 2.8Level 2.4Level 2 looks like: Encourage a coworker who is having difficulty finishing a project
- NegotiationImportance 2.6Level 2.6Level 2 looks like: Present justification to a manager for altering a work schedule
- MathematicsbasicImportance 2.3Level 2.5Level 2 looks like: Count the amount of change to be given to a customer
- Operations MonitoringImportance 2.3Level 1.9Level 2 looks like: Monitor completion times while running a computer program
- Quality Control AnalysisImportance 1.9Level 1.6Level 2 looks like: Inspect a draft email for errors (e.g., grammar, punctuation)
- Management of Material ResourcesImportance 1.9Level 1.5Level 2 looks like: Reserve a room for a management meeting
- TroubleshootingImportance 1.8Level 1.0Level 2 looks like: Identify the source of a leak by looking under a machine
- Management of Financial ResourcesImportance 1.6Level 1.0Level 2 looks like: Use available funds to buy office supplies and record the amount of the purchase
- ProgrammingImportance 1.6Level 0.8
- Technology DesignImportance 1.6Level 0.8
- Operation and ControlImportance 1.5Level 0.9
- Equipment SelectionImportance 1.5Level 0.6
- Operations AnalysisImportance 1.4Level 0.5
- Equipment MaintenanceImportance 1.0Level —
- InstallationImportance 1.0Level —
- RepairingImportance 1.0Level —
Tasks
34 core · 2 supplementalWhat people in this occupation do, as O*NET records it, core tasks first by importance (1–5).
- Monitor maternal condition during labor by checking vital signs, monitoring uterine contractions, or performing physical examinations.Importance 4.7
- Identify tubal and ectopic pregnancies and refer patients for treatments.Importance 4.7
- Conduct ongoing prenatal health assessments, tracking changes in physical and emotional health.Importance 4.6
- Establish and follow emergency or contingency plans for mothers and newborns.Importance 4.6
- Identify, monitor, or treat pregnancy-related problems such as hypertension, gestational diabetes, pre-term labor, or retarded fetal growth.Importance 4.6
- Monitor fetal growth and well-being through heartbeat detection, body measurement, and palpation.Importance 4.6
- Provide necessary medical care for infants at birth, including emergency care such as resuscitation.Importance 4.6
- Evaluate patients' laboratory and medical records, requesting assistance from other practitioners when necessary.Importance 4.5
- Obtain complete health and medical histories from patients including medical, surgical, reproductive, or mental health histories.Importance 4.5
- Set up or monitor the administration of oxygen or medications.Importance 4.4
- Assess the status of post-date pregnancies to determine treatments and interventions.Importance 4.4
- Maintain documentation of all patients' contacts, reviewing and updating records as necessary.Importance 4.4
Show the other 24
- Perform post-partum health assessments of mothers and babies at regular intervals.Importance 4.4
- Suture perineal lacerations.Importance 4.4
- Provide information about the physical and emotional processes involved in the pregnancy, labor, birth, and postpartum periods.Importance 4.3
- Test patients' hemoglobin, hematocrit, and blood glucose levels.Importance 4.3
- Counsel women regarding the nutritional requirements of pregnancy.Importance 4.3
- Assist maternal patients to find physical positions that will facilitate childbirth.Importance 4.2
- Provide comfort and relaxation measures for mothers in labor through interventions such as massage, breathing techniques, hydrotherapy, or music.Importance 4.2
- Assess birthing environments to ensure cleanliness, safety, and the availability of appropriate supplies.Importance 4.2
- Estimate patients' due dates and re-evaluate as necessary based on examination results.Importance 4.2
- Refer patients to specialists for procedures such as ultrasounds or biophysical profiles.Importance 4.2
- Incorporate research findings into practice as appropriate.Importance 4.2
- Collect specimens for use in laboratory tests.Importance 4.1
- Provide, or refer patients to other providers for, education or counseling on topics such as genetic testing, newborn care, contraception, or breastfeeding.Importance 4.1
- Provide patients with contraceptive and family planning information.Importance 4.1
- Respond to breech birth presentations by applying methods such as exercises or external version.Importance 4.0
- Inform patients of how to prepare and supply birth sites.Importance 4.0
- Perform annual gynecologic exams, including pap smears and breast exams.Importance 4.0
- Develop, implement, or evaluate individualized plans for midwifery care.Importance 3.9
- Provide information about community health and social resources.Importance 3.8
- Recommend the use of vitamin and mineral supplements to enhance the health of patients and children.Importance 3.8
- Compile and evaluate clinical practice statistics.Importance 3.5
- Treat patients' symptoms with alternative health care methods such as herbs or hydrotherapy.Importance 3.5
- Complete birth certificates.Importance 4.0
- Collaborate in research studies.Importance 3.3
Knowledge
Bodies of knowledge the work draws on.
- Customer and Personal ServiceImportance 4.6Level 5.9
- Medicine and DentistryImportance 4.5Level 5.5Level 4 looks like: Fill a tooth cavity
- PsychologyImportance 4.2Level 5.2Level 4 looks like: Understand the impact of alcohol on human responses
- Therapy and CounselingImportance 3.9Level 5.0Level 4 looks like: Provide job counseling to the unemployed
- English LanguageImportance 3.6Level 4.1Level 4 looks like: Edit an article for a news website
- BiologyImportance 3.5Level 3.9Level 4 looks like: Investigate the effects of pollution on marine plants and animals
- Education and TrainingImportance 3.5Level 4.7Level 4 looks like: Lead a quality improvement seminar
- Sociology and AnthropologyImportance 3.3Level 4.4Level 4 looks like: Write an article about cultural differences
Show all 33
- Administration and ManagementImportance 3.0Level 3.1Level 4 looks like: Monitor progress of a project to ensure timely completion
- Law and GovernmentImportance 2.9Level 3.0Level 4 looks like: Prepare documents and title papers for the purchase of a new house
- Personnel and Human ResourcesImportance 2.7Level 3.3Level 4 looks like: Interview applicants for an administrative position
- AdministrativeImportance 2.6Level 4.1Level 4 looks like: Type 30 words per minute
- ChemistryImportance 2.6Level 2.8
- Computers and ElectronicsImportance 2.6Level 3.3Level 4 looks like: Use a computer to format a document
- Philosophy and TheologyImportance 2.5Level 3.0Level 4 looks like: Understand another culture's religious practices
- Public Safety and SecurityImportance 2.5Level 2.2Level 1 looks like: Use a seatbelt
- Sales and MarketingImportance 2.5Level 2.8
- Communications and MediaImportance 2.3Level 2.2Level 1 looks like: Write a thank you note
- MathematicsImportance 2.1Level 1.9Level 1 looks like: Add two numbers
- Foreign LanguageImportance 2.0Level 1.5Level 1 looks like: Say "please" and "thank you" in a foreign language
- TelecommunicationsImportance 2.0Level 0.8Level 1 looks like: Send an email
- Economics and AccountingImportance 1.9Level 1.1Level 1 looks like: Answer billing questions from credit card customers
- TransportationImportance 1.9Level 1.4Level 1 looks like: Ride a train to work
- GeographyImportance 1.5Level 1.1Level 1 looks like: Know the capital of the United States
- PhysicsImportance 1.5Level 0.8Level 1 looks like: Use a crowbar to pry open a box
- History and ArcheologyImportance 1.4Level 0.7Level 1 looks like: Take a class in US history
- MechanicalImportance 1.4Level 0.9Level 1 looks like: Replace the filters in a furnace
- Engineering and TechnologyImportance 1.3Level 0.7Level 1 looks like: Install a door lock
- Production and ProcessingImportance 1.3Level —
- Building and ConstructionImportance 1.1Level —
- DesignImportance 1.1Level —
- Fine ArtsImportance 1.1Level —
- Food ProductionImportance 1.0Level —
Abilities
Enduring capacities the work calls for.
- Deductive ReasoningImportance 4.0Level 4.6Level 5 looks like: Decide what factors to consider in selecting stocks
- Inductive ReasoningImportance 4.0Level 4.4Level 4 looks like: Determine the prime suspect based on crime scene evidence
- Oral ComprehensionImportance 4.0Level 4.4Level 4 looks like: Understand a coach's oral instructions for a sport
- Oral ExpressionImportance 4.0Level 4.3Level 4 looks like: Give instructions to a lost motorist
- Problem SensitivityImportance 4.0Level 5.1Level 6 looks like: Recognize an illness at an early stage of a disease when there are only a few symptoms
- Written ComprehensionImportance 3.9Level 4.1Level 4 looks like: Understand an apartment lease
- Speech ClarityImportance 3.8Level 3.6Level 4 looks like: Make stadium-wide announcements during a sporting event
- Information OrderingImportance 3.5Level 3.8Level 2 looks like: Follow the correct steps to make change
Show all 52
- Near VisionImportance 3.5Level 3.5Level 2 looks like: Read indicators on the dashboard of a car
- Speech RecognitionImportance 3.5Level 3.6Level 4 looks like: Identify a former customer's voice over the phone
- Written ExpressionImportance 3.5Level 4.0Level 4 looks like: Write a job recommendation for a subordinate
- Category FlexibilityImportance 3.3Level 3.3Level 3 looks like: Classify flowers according to size, color, and smell
- Selective AttentionImportance 3.3Level 3.9Level 4 looks like: Watch security monitors for intruders throughout the night shift
- Flexibility of ClosureImportance 3.1Level 3.4Level 4 looks like: Look for a golf ball in tall grass
- Arm-Hand SteadinessImportance 3.0Level 3.6Level 4 looks like: Thread a needle
- Fluency of IdeasImportance 3.0Level 3.4Level 4 looks like: Think of as many ideas as possible for the name of a new company
- Perceptual SpeedImportance 3.0Level 3.0Level 2 looks like: Sort mail according to ZIP codes with no time pressure
- Finger DexterityImportance 2.9Level 3.0Level 2 looks like: Put coins in a parking meter
- OriginalityImportance 2.9Level 3.0Level 2 looks like: Use a credit card to open a locked door
- MemorizationImportance 2.8Level 2.9
- Multilimb CoordinationImportance 2.8Level 2.9Level 2 looks like: Row a boat
- Speed of ClosureImportance 2.8Level 2.9Level 3 looks like: Recognize a song after hearing only the first few notes
- Time SharingImportance 2.8Level 2.8Level 3 looks like: Watch street signs while driving at 30 miles an hour
- Visual Color DiscriminationImportance 2.8Level 2.8
- Far VisionImportance 2.6Level 2.6Level 2 looks like: Read a roadside billboard
- VisualizationImportance 2.6Level 2.9Level 2 looks like: Imagine how to place paper in a printer so that the letterhead comes out on top
- Manual DexterityImportance 2.5Level 2.6
- Trunk StrengthImportance 2.5Level 2.3Level 2 looks like: Sit up in an office chair
- Auditory AttentionImportance 2.4Level 2.1Level 2 looks like: Listen to a lecture while people nearby are talking
- Hearing SensitivityImportance 2.4Level 2.1Level 2 looks like: Notice a doorbell ringing
- Extent FlexibilityImportance 2.3Level 2.3Level 2 looks like: Reach to adjust the radio in a car
- Mathematical ReasoningImportance 2.3Level 2.4Level 1 looks like: Determine how much 20 oranges will cost when they are priced at 5 for 4 dollars
- Number FacilityImportance 2.3Level 2.5Level 3 looks like: Calculate a discounted price
- Static StrengthImportance 2.3Level 2.1Level 1 looks like: Push an empty shopping cart
- StaminaImportance 2.1Level 1.9Level 1 looks like: Walk 1/4 mile
- Wrist-Finger SpeedImportance 2.1Level 1.9Level 2 looks like: Use a screwdriver to twist in a screw
- Control PrecisionImportance 2.0Level 1.9Level 2 looks like: Adjust a room light with a dimmer switch
- Depth PerceptionImportance 2.0Level 2.0Level 2 looks like: Merge a car into traffic on a city street
- Dynamic StrengthImportance 2.0Level 1.6Level 2 looks like: Use pruning shears to trim a bush
- Gross Body CoordinationImportance 1.9Level 1.5Level 2 looks like: Get in and out of a truck
- Reaction TimeImportance 1.9Level 1.5Level 2 looks like: Start to slow down the car when a traffic light turns yellow
- Response OrientationImportance 1.9Level 1.9Level 2 looks like: When a doorbell and phone ring at the same time, quickly select which to answer first
- Gross Body EquilibriumImportance 1.6Level 0.6
- Rate ControlImportance 1.5Level 0.8Level 1 looks like: Ride a bicycle alongside a jogger
- Explosive StrengthImportance 1.4Level 0.5
- Dynamic FlexibilityImportance 1.3Level —
- Speed of Limb MovementImportance 1.1Level —
- Glare SensitivityImportance 1.0Level —
- Night VisionImportance 1.0Level —
- Peripheral VisionImportance 1.0Level —
- Sound LocalizationImportance 1.0Level —
- Spatial OrientationImportance 1.0Level —
Work activities
Kinds of activity the work is made of.
- Assisting and Caring for OthersImportance 4.7Level 6.2Level 7 looks like: Care for seriously injured persons in an emergency room
- Documenting/Recording InformationImportance 4.5Level 5.3Level 4 looks like: Document the results of a crime scene investigation
- Establishing and Maintaining Interpersonal RelationshipsImportance 4.4Level 5.5Level 4 looks like: Maintain good working relationships with almost all coworkers and clients
- Making Decisions and Solving ProblemsImportance 4.4Level 5.6
- Getting InformationImportance 4.3Level 5.0Level 4 looks like: Review a budget
- Identifying Objects, Actions, and EventsImportance 4.3Level 5.9
- Communicating with Supervisors, Peers, or SubordinatesImportance 4.2Level 4.8Level 4 looks like: Report the results of a sales meeting to a supervisor
- Updating and Using Relevant KnowledgeImportance 4.1Level 5.2Level 4 looks like: Keep current on changes in maintenance procedures for repairing sports cars
Show all 41
- Inspecting Equipment, Structures, or MaterialsImportance 4.0Level 4.3Level 4 looks like: Inspect equipment in a chemical processing plant
- Monitoring Processes, Materials, or SurroundingsImportance 4.0Level 5.8
- Performing for or Working Directly with the PublicImportance 4.0Level 4.5Level 4 looks like: Sell shoes in a crowded shoe store
- Analyzing Data or InformationImportance 3.9Level 4.7Level 4 looks like: Determine the interest cost to finance a new building
- Communicating with People Outside the OrganizationImportance 3.9Level 4.9Level 4 looks like: Present information to potential clients about available services
- Evaluating Information to Determine Compliance with StandardsImportance 3.9Level 4.7Level 4 looks like: Evaluate a complicated insurance claim for compliance with policy terms
- Interpreting the Meaning of Information for OthersImportance 3.9Level 3.9Level 4 looks like: Interpret how foreign tax laws apply to U.S. exports
- Organizing, Planning, and Prioritizing WorkImportance 3.9Level 5.2Level 4 looks like: Plan and adjust a personal to-do list according to changing demands
- Processing InformationImportance 3.9Level 4.9Level 4 looks like: Calculate the adjustments for insurance claims
- Judging the Qualities of Objects, Services, or PeopleImportance 3.8Level 4.8Level 4 looks like: Determine the value of property lost in a fire
- Providing Consultation and Advice to OthersImportance 3.8Level 4.4Level 4 looks like: Recommend a new software package to increase operational efficiency
- Scheduling Work and ActivitiesImportance 3.8Level 4.6Level 4 looks like: Prepare the work schedule for salesclerks in a large retail store
- Training and Teaching OthersImportance 3.8Level 4.8Level 4 looks like: Teach a social sciences course to high school students
- Developing and Building TeamsImportance 3.7Level 4.0Level 4 looks like: Lead an assembly team in an automobile plant
- Resolving Conflicts and Negotiating with OthersImportance 3.7Level 4.7Level 4 looks like: Get two subordinates to agree about vacation schedules
- Coaching and Developing OthersImportance 3.6Level 4.4Level 4 looks like: Provide on-the-job training for administrative workers
- Performing General Physical ActivitiesImportance 3.6Level 3.9Level 4 looks like: Paint the outside of a house
- Developing Objectives and StrategiesImportance 3.5Level 4.2Level 4 looks like: Develop the plan to complete the merger of two organizations over a 3-year period
- Working with ComputersImportance 3.5Level 3.3Level 4 looks like: Write software for keeping track of parts in inventory
- Estimating the Quantifiable Characteristics of Products, Events, or InformationImportance 3.4Level 4.0Level 4 looks like: Estimate the time required to evacuate a city in the event of a major disaster
- Guiding, Directing, and Motivating SubordinatesImportance 3.4Level 4.0Level 4 looks like: Manage a small team of employees in a dynamic workplace
- Thinking CreativelyImportance 3.3Level 4.3Level 4 looks like: Adapt popular music for a high school marching band
- Performing Administrative ActivitiesImportance 3.2Level 4.0Level 4 looks like: Complete tax forms for a small business
- Coordinating the Work and Activities of OthersImportance 3.1Level 3.5Level 4 looks like: Organize the cleanup crew after a major sporting event
- Handling and Moving ObjectsImportance 3.1Level 4.0Level 4 looks like: Arrange books in a library
- Monitoring and Controlling ResourcesImportance 3.1Level 3.6Level 4 looks like: Work as a chef responsible for ordering food for the menu
- Selling or Influencing OthersImportance 3.1Level 3.7Level 4 looks like: Make a sales pitch to convince others to buy a product
- Staffing Organizational UnitsImportance 2.7Level 3.3Level 4 looks like: Interview candidates for a sales position and make hiring recommendations
- Controlling Machines and ProcessesImportance 2.4Level 2.5Level 1 looks like: Operate a cash register
- Repairing and Maintaining Mechanical EquipmentImportance 2.3Level 2.4Level 1 looks like: Make simple, external adjustments to a door hinge with ordinary hand tools
- Operating Vehicles, Mechanized Devices, or EquipmentImportance 2.1Level 1.9Level 1 looks like: Drive a car
- Drafting, Laying Out, and Specifying Technical Devices, Parts, and EquipmentImportance 1.8Level 1.6Level 1 looks like: Specify the lighting for a work area
- Repairing and Maintaining Electronic EquipmentImportance 1.8Level 1.4Level 1 looks like: Use display settings to adjust a television picture
Work context
The conditions most characteristic of the work, on O*NET's 1–5 context scale.
Technology
12 toolsSoftware used in this work. In demand: among the tools job postings for this occupation name most. Hot: often named in job postings across the economy.
In demand (1)
- Epic Systemshot
Hot (6; 1 more marked hot above)
- Extensible markup language XML
- MEDITECH software
- Microsoft Excel
- Microsoft Office software
- Microsoft PowerPoint
- Microsoft Word
Other tools (5)
- AS/400 Database
- Email software
- Patient electronic medical record EMR software
- Private Practice
- Web browser software
Related occupations
O*NET's own list of the occupations most related to this one, closest first.
ESCO equivalents
From the official ESCO–O*NET crosswalk, strongest match first. A broader occupation takes in this one; a narrower one is a part of it.
Closest occupations
Compare any occupation →Other O*NET occupations whose importance ratings on the 35 skills both rate are nearest to this one's, with the biggest differences named. A plain rule, not a hidden score.
Nurse Midwives
Average difference 0.2 points · Operations Analysis +1.0, Writing +0.8
O*NET · Zone 5 · Compare
Licensed Practical and Licensed Vocational Nurses
Average difference 0.2 points · Operation and Control +1.1, Mathematics +0.6
O*NET · Zone 3 · Compare
Registered Nurses
Average difference 0.2 points · Quality Control Analysis +1.0, Operation and Control +0.8
O*NET · Zone 4 · Compare
Dermatologists
Average difference 0.2 points · Science +0.7, Monitoring −0.5
O*NET · Zone 5 · Compare
Music Therapists
Average difference 0.2 points · Science −1.1, Negotiation +0.7
O*NET · Zone 4 · Compare
Chiropractors
Average difference 0.2 points · Coordination −0.7, Monitoring −0.7
O*NET · Zone 5 · Compare
Psychiatric Technicians
Average difference 0.2 points · Science −0.9, Judgment and Decision Making −0.8
O*NET · Zone 3 · Compare
Paramedics
Average difference 0.2 points · Operation and Control +1.5, Systems Evaluation −0.7
O*NET · Zone 3 · Compare
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This page includes information from the O*NET 31.0 Database by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA), used under the CC BY 4.0 license; O*NET® is a trademark of USDOL/ETA. ESCO occupations and skills are from the European Commission's ESCO classification, and the occupation crosswalk is the official ESCO–O*NET mapping by the ESCO Secretariat with USDOL/ETA. This service uses the ESCO classification of the European Commission. BlissPoint Analytics has modified all or some of this information: skill, task and descriptor ratings are rounded to one decimal, and ESCO occupations show Job Zone and interests copied from a crosswalked O*NET occupation. USDOL/ETA has not approved, endorsed, or tested these modifications.