CPS/CRS Interview Form

CPS/CRS Interview Form
Applicant Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Interview*

MonthDayYear
Date
Person Conducting Interview*

First NameLast 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?*
All of our documentation is completed on an iPad, how much experience do you have using an iPad or similar type of device?*
If i talked to your previous supervisor, what would they say are 3 strengths and 3 things you could be improving?*
Have you ever been convicted of a crime (felony or misdemeanor)? ***If YES, applicant will need to submit 2 letters of recommendation and an explanation of charges within 7 DAYS of the interview***DO NOT ASK THIS QUESTION IF APPLICANT RESIDES IN PHILADELPHIA OR PITTSBURGH****

YesNoN/A
Have you ever been excluded from participation in Medicare, Medicaid, or the Pennsylvania Medical Assistance Programs?*

YesNo
Have you completed teh 2-week certification training in Pennsylvania?*

YesNo
Are you a Certified Peer Specialist or Certified Recovery Specialist with the Pennsylvania Certification Board (PCB)?*

CPSCRSBothNeither
Have you served in the military?*

YesNo
Do you have adequate transportation and/or a valid driver's license?*

YesNo
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?*

DayEveningWeekendsAnyOther
Other
Check all animals applicant is comfortable working around?*

DogsCats
Are you able to work around individuals that smoke?*

YesNo
Are you interested in working with the forensic population?*

YesNo
Are you interested in working with individuals with substance use disorder?*

YesNo
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?*

YesNo
Is there any specific issues/diagnosis to avoid when staffing?*

YesNo
If yes, please list what specific issues/diagnosis to avoid
CPS Minimum Qualifications
Do they have a mental health diagnosis and have reached a place in their recovery pathway where they can positively support others in similar situation?

YesNo
Do they have a High School Diploma or GED (Preferred)?

YesNo
Does their resume document work/volunteer experience of at least 6 months of consecutive employment or volunteer work experience; OR within the last 3 years, has maintained at least 12 months of successful full or part-time paid or volunteer work experience? (Preferred)

YesNo
Is the applicant an effective communicator?

YesNo
CRS Minimum Qualifications
Do you have lived substance use history and recovery experience?

YesNo
Do you have a minimum of 18 months of continuous recovery experience?

YesNo
Do you regularly and actively participate in a recovery program? (All pathways to recovery are included, this does not mean you have to be involved in a 12 step recovery program)?

YesNo
Do you have a High School Diploma or GED?

YesNo
Do you have documentation of work/volunteer experience? (12 months of full or part-time paid, or volunteer experience within the last 36 months OR obtained at least 24 credit hours of post-secondary education)?

YesNo
Additional Information
Reviewed onboarding schedule with applicant*

YesNo
Do you want to hire this applicant?*

YesNoUnsure
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CPS/CRS Interview Form

Interview Questions

CPS Minimum Qualifications

CRS Minimum Qualifications

Additional Information