Simple Job Application Form - White and Responsive

Full Name*

First NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address*

Phone Number*

Area CodePhone Number

Applying for Position*

Do you have a current and valid CHW Certificate or License that allows your service to be billed to health insurance?*

YesNo, but I am actively pursuingNo, but I am interested in learning moreMaybe, I need help with this question

Do you have a current license or certification or training in any wellness profession (e.g., cosmetology, nail tech, massage, barbering, hair braiding, yoga)?*

YesNo, but I am actively pursuingNo, but I am interested in learning moreMaybe, I need help with this question

List all relevant certifications/licenses for your CHW, wellness, beauty, or related health training experience. If you have none, you can still apply and learn more through the process.*

What areas of service are you most interested in providing or have experience providing as a consultant?*

General CHW Services (health navigation, education/coaching, advocacy, outreach, and referrals)Perinatal Health/Maternal-Child ServicesChronic Disease SupportMental Health & WellnessSelf-Grooming & Hygiene Education (i.e. Hair, Skin, Nail)Other

What types of spaces are you most interested in delivering services in?*

Do you have a private spae or partner site you could use to deliver services*

Yes, I feel confident I have a comfortable, welcoming space where private, confidential conversations could take place between me and my client/patient.No, but I am open to placement suggestions.Maybe, I have a space in mind but I am not sure if it is appropriate/ready - Can Moyo assist me?

What type of schedule do you think may work best for you, knowing you may need to change it to meet your personal needs?*

How many hours per week would you want to work as a Moyo Health consultant?*

Less than 10 hours/week10-20 hours/week20-30 hours/week30+ hours/week

Do you have access to reliable transportation*

YesNo

Please describe your experience working with community members, patients, or clients when it comes to social services, health or wellness topics.*

Are you comfortable using basic technology for scheduling, documentation, and training? If yes, please share your experience.*

YesDepends on the technologyI'm able to learn almost anything with support

What communities do you feel most connected to, have the most experience with, or would like to focus on serving? Note, A “community” can be defined in many ways, including but not limited to shared characteristics such as age, gender, race, ethnicity, sexual identity, geographic region, culture, religion, disability status, or lived experience. *

Why are you interested in working as an Independent Consultant with Moyo Health? What do you like most about this opportunity?*

Moyo Health's vision statement is: Reimagining Space of Care, for the community, by the community. What does this statement mean to you based on your professional or personal experience?*

Do you have any questions you'd like to discuss if invited to interview?*

Start date

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Upload Resume/Cover Letter*

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Upload additional documents to supplement application if desired

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Apply to become an Independent CHW Consultant with Moyo Health