Onboarding Peer Specialist Checklist
Person completing interview
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Applicant Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County Applicant lives in?
Position Applying for?
Certified Peer Specialist
Certified Recovery Specialist
CPS Qualifications
Which counties are you interested working in?
Why does this position interest you?
What supports and training do you think you need to perform well in this position?
All of our documentation is completed on an iPad, how much experience do you have using iPad or other similar types of devices?
If I talked to your previous supervisor, what would he or she say are your 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**
Yes
No
N/A
Have you ever been excluded from participation in Medicare, Medicaid, or the Pennsylvania Medical Assistance Programs?
Yes
No
Have you completed the 2 week certification training in Pennsylvania?
Yes
No
Are you a Certified Peer Specialist with the Pennsylvania Certification Board (PCB)?
Yes
No
If yes, was this verified on PCB site by onboarding specialist?
Yes
No
Have you served in the military?
Yes
No
Do you have adequate transportation and/or a valid driver's license?
Yes
No
Highest level of education
Less than high school
High School/GED
Some College
2 year college (Assoc. Degree)
4 year college (BA/BS Degree
Masters Degree
Doctoral Degree
Professional Degree (e.g. MD or JD)
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 a similar situation?
Yes
No
Do they have a High School Graduate or GED (Preferred)
Yes
No
Does their resume document work/volunteer experience of at least 6 months of consecutive employment or volunteer work experience; OR within the last three (3) years, has maintained at least 12 months of successful full or part-time paid or volunteer work experience? (Preferred)
Yes
No
Is the applicant an effective communicator?
Yes
No
Date applicant is available for Peer Support Certification Training. List which training and date applicant is able to attend or N/A*
CRS Qualifications
Do you have lived substance use history and recovery experience?
Yes
No
Do you have a minimum of 18 months of continuous recovery experience?
Yes
No
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)
Yes
No
Do you have a High School Diploma or a GED?
Yes
No
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)
Yes
No
Do you have adequate transportation and/or a valid driver's license?
Yes
No
Is the applicant an effective communicator?
Yes
No
Have you competed the CRS Certifications training in Pennsylvania?
Yes
No
Was this verified on the PCB site by onboarding specialist?
Yes
No
Are you comfortable using a computer independently?
Yes
No
Do you have access to high speed internet?
Yes
No
Can you commit to attend a live 66 hour training? (You CANNOT miss any days, come late, or leave early)
Yes
No
Can you commit to completing the 12 hours of required homework?
Yes
No
Please check the items you have viewed
Drivers License
Social Security Card
Degree (Supervisors Only)
Applicant scheduled for RD interview?
Yes
No
If yes date/time
Did this applicant respond to an AD that listed a sign-on bonus? If so, what amount was advertised?
Submit
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