Regional Director CPS Interview Form
Applicant Name
First Name
Last Name
Date of Interview
-
Month
-
Day
Year
Date
Person Conducting the Interview
First Name
Last Name
Applicant county of residence
Interview Questions
What are your reasons for wanting to work as a peer specialist?
Please tell me about any education, training, or personal experience that prepares you for being a CPS?
Peerstar is a recovery focused organization, how would you describe the concept of recovery to someone you were assigned to support?
This position has been advertised for a consumer survivor of the mental health system. How would you use your own losses and recovery to instill hope in our peers?
How willing and comfortable are you to speak with Peers about your own experiences with mental health problems and your own recovery process? How do you feel about self-disclosure?
Additional Information
How many hours are you interested in working?
What counties/areas are you interested in working?
How far from your home are you willing to work? (Minutes)
What times are you available to work?
Day
Evening
Weekends
Any
Other
Other
Check all animals applicant is comfortable working around?
Dogs
Cats
Are you able to work around individuals that smoke?
Yes
No
Date applicants if available for RD Orientation?
-
Month
-
Day
Year
Date
Date applicant is available to start with Peers?
-
Month
-
Day
Year
Date
Are you interested in working with the forensic population?
Yes
No
Are you interested in working with individuals with substance use disorder?
Yes
No
Tell me about your experience working with, or being around someone, with an intellectual disability or autism? If no experience, put "N/A"
Will the applicant attend Dual Diagnosis Training?
Yes
No
If yes, list date applicant is able to attend training
-
Month
-
Day
Year
Date
Is there any specific issues/diagnosis to avoid when staffing?
Yes
No
If yes, please list what specific issues/diagnosis to avoid
Is there anything else you want to tell me about yourself and why we should choose you over other candidates?
Is the candidate already CPS certified?
Yes
No
Do you want to hire this applicant?
Yes
No
Unsure
Submit
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