ATTW PERSONNEL | Peer Coach Survey

ATTW Personnel Recruiting Survey
Date

MonthDayYear
Date
Full name

First NameLast Name
Company name / DBA (if it applies)
Legal Address 1 *
Address 2
State/Province/Region *
Zip/Postal Code *
City *
Cell phone number *
Email address*
Date of birth

MonthDayYear
Date
Age: *
Numeric values
Gender *
Ethnicity

American Indian or Alaska NativeAsianAfrican AmericanCaucasianHispanic or LatinoNative Hawaiian or Other Pacific Islander
Tell us about yourself and what drives you to apply to work with All The Way Well
Current employment status *
Resume*

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Recent photo of yourself - This photo will be used for your email signature and or business card. Please see the Operations Manager is this is problematic for you. *

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Tell us about your most recent position and why you're interesting in becoming a Peer Coach with All The Way Well. *
How do you align with All The Way Well's mission and vision? *
How does this position align with your personal and professional goals? *
LinkedIn or other professional portfolio page link:
Please tell us about any accolades or accomplishments you've achieved over the last three years that you are the most proud of. *
Education
What level of education have you received*

GEDHigh School - DiplomaSome CollegeAssociates degreeBachelors degreeMasters degreeDoctoral degree
Major / Field of study
Please upload a copy of any certifications or degrees you hold that apply to this position

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Professional Referrals
Referral 1 Name: *
Referral 1 Occupation: *
Referral 1 Relationship: *
Referral 1 Phone: *
Referral 2 Name: *
Referral 2 Occupation: *
Referral 2 Relationship: *
Referral 2 Phone: *
Background Information
Do you have a criminal background? (If so, please explain) *
Do you have any medical conditions we should be aware of ? *
Are you currently on probation / parole or any other forms of legal supervision? *
Do you have at least two years of lived experience with Substance Use Disorder ? *
Healthcare / Community Improvement Experience
Do you have any professional experience working in the Healthcare Industry?*

No< 1 year> 1 year> 5 years
Have you worked in a position requiring HIPAA Compliance? *
Please elaborate on any experience you have working in social service, case management, and or customer service. *
Please upload a certificate of insurance if you have one (GL/E&O or other professional policies)

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Professional Systems and Tools

Tell us about your experience using the following platforms
Google Business Suite (Gmail / Drive) - Rank 1 (little or no experience) - 5 (Super Admin) *

1

2

3

4

5

1 is Worst, 5 is Best
CRM Tools - SalesForce / HubSpot - Rank 1 (little or no experience) - 5 (Super Admin) *

1

2

3

4

5

1 is Worst, 5 is Best
Slack / Whatsapp - Rank 1 (little or no experience) - 5 (Super Admin) *

1

2

3

4

5

1 is Worst, 5 is Best
Canva / Adobe - Rank 1 (little or no experience) - 5 (Super Admin) *

1

2

3

4

5

1 is Worst, 5 is Best
Based on the documentation requirements of this position there is a lot of typing involved in this position. Please complete the following typing tests, take a print screen of the results, and upload your results in the following upload section.

Typing test link: - https://www.speedtypingonline.com/typing-test

Print screen on a Windows computer = CTRL + PRTSCN

Print screen on a MAC = Command + Shift + 4
Upload your typing test results - *

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We're all about THRIVING and managing to strengths, so how can we help you THRIVE in this position?
What are your key strengths? *
What are some of your weaknesses? *
What team and leadership skills are your strongest? *
Do you have any additional skills or experiences that apply to this position? *
What is your biggest RESERVATION about this position?
Please select any experience (trained or lived) you have in the following areas;*

Substance use disorderAnger managerMental HealthEating disordersGrief managementAA - AttendeeAA - Sponsor
Closing Details
How did you hear about All The Way Well? *
Are you willing to donate time other non-profit organizations ?*
What other non-profit organizations have you worked with in the past?
Do you have reliable means of transportation? *
This position requires a fair amount of driving as we have multiple homes and meeting across the front range from Westminster to Centennial.

What is your weekly availability ? *

	Mornings (8-12)	Afternoon (1-5)	Evenings (5-9)	Not Available	All Day (8-5)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
After hours / Holidays

Overall, how many hours per week are you available to support ATWW? *
When are you available to start?

MonthDayYear
Date
What is your income target for this position? *
Position:
Base Income
PRS Start Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Weekly Hours Required
Should be Empty:

ATTW Personnel Recruiting Survey

Tell us about yourself and what drives you to apply to work with All The Way Well

Education

Professional Referrals

Background Information

Healthcare / Community Improvement Experience

Professional Systems and Tools

We're all about THRIVING and managing to strengths, so how can we help you THRIVE in this position?

Closing Details