Application: Addictions Specialist/Intake Coordinator (200272) Job at Journey Mental Health Center in Madison, WI

Journey Mental Health Center, Inc. (JMHC) is an Equal Opportunity, Affirmative Action Employer. It is our policy to provide placement, employment, compensation and other benefits based on qualifications, without regard to race, color, religion, national origin, age, gender, sexual orientation, veteran status or disability or any other basis prohibited by federal or state law. JMHC intends to comply with all federal and state laws, and the information provided will not be used for any purpose prohibited by law. If you are a person with a disability, you may request needed accommodation at any time during this process.

Q1. If the job requires use of a motor vehicle, do you have a valid driver license?

Yes
No

Q2. Do you have access to a vehicle?

Yes
No

Q3. If the job requires unusual hours (including weekends and nights) would you be willing to accept it?

Yes
No

Q4. When would you be available for employment?

Q5. Are you currently staff at JMHC?

Yes
No

Q6. If yes, what is the title of you current position?

Q7. Have you ever been a staff member, paid or non-paid, at JMHC?

Yes
No

Q8. If yes, please indicate your previous role with JMHC. Choose all that apply.

Paid Staff
Student
Volunteer
Contractor

Q9. Previously you noted your education. Please indicate the field of study and the year conferred for the highest degree. If you don't have an advanced degree, please write "Not Applicable."

Q10. If you hold a license or registration to practice in Wisconsin as a member of a profession or trade, please indicate the type of license or registration.

Q11. Please describe any special skills or qualifications that you possess that you feel are relevant (i.e. specific expertise, proficiency in a second language, exceptional computer knowledge, etc.)

Q12. Briefly describe experiences you have shared with people whose culture, attitudes, beliefs, values or backgrounds were different from yours. Explain what insights and/or interpersonal skills have you gained as a result of those experiences.

Q13. Please provide the names, email addresses, and telephone number of three references.

Q14. How did you find out about this opening? Providing specific information is extremely valuable to us.

PLEASE READ THESE INSTRUCTIONS CAREFULLY TO ASSURE CONSIDERATION OF YOUR APPLICATION!

Employment History:

We value all employment experience candidates bring. We evaluate, screen and CALCULATE COMPENSATION using the information submitted ON THIS APPLICATION. "See Resume" is NOT acceptable.

If you don't have additional employment history to add to your application, please use "N/A" as the fields require an answer. If you have more experience than the space on the application allows, please attach a document that answers the same application questions for additional experiences.

Thank you in advance for the time and energy required to provide complete and thorough application materials.

Q15. Most Recent Employer

Q16. May we contact this employer?

Yes
No

Q17. Name and telephone number of your supervisor.

Q20. How many hours per week did you work?

Q21. Please describe your responsibilities.

Q22. What is/was your reason for leaving?

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Q23. Additional Employment History - EMPLOYER B

Q24. May we contact this employer? - EMPLOYER B

Yes
No

Q25. Name and telephone number of your supervisor. - EMPLOYER B

Q26. Start Date - EMPLOYER B

Q27. End Date - EMPLOYER B

Q28. How many hours per week did you work? - EMPLOYER B

Q29. Please describe your responsibilities. - EMPLOYER B

Q30. What is/was your reason for leaving? - EMPLOYER B

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Q31. Additional Employment History - EMPLOYER C

Q32. May we contact this employer? - EMPLOYER C

Yes
No

Q33. Name and telephone number of your supervisor. - EMPLOYER C

Q34. Start Date - EMPLOYER C

Q35. End Date - EMPLOYER C

Q36. How many hours per week did you work? - EMPLOYER C

Q37. Please describe your responsibilities. - EMPLOYER C

Q38. What is/was your reason for leaving? - EMPLOYER C

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Q39. Additional Employment History - EMPLOYER D

Q40. May we contact this employer? - EMPLOYER D

Yes
No

Q41. Name and telephone number of your supervisor. - EMPLOYER D

Q42. Start Date - EMPLOYER D

Q43. End Date - EMPLOYER D

Q44. How many hours per week did you work? - EMPLOYER D

Q45. Please describe your responsibilities. - EMPLOYER D

Q46. What is/was your reason for leaving? - EMPLOYER D

If you have additional experience, please provide a document that answers the same questions as this application. NOTE that this information is used to determine compensation.

CERTIFICATION

I hereby certify that the information I have provided in this application is true. I authorize JMHC representatives to contact references, past or present employers (unless specifically stated), persons, schools, law enforcement agencies and any other sources of information that may be relevant to my application for employment. It is understood and agreed that any misrepresentation, false statement or omissions may be sufficient reason for rejection or for dismissal at any time during my employment, without liability to JMHC. In addition, I understand and agree that, as a condition of my employment with Journey Mental Health Center, Inc., I will be required to submit information for a criminal history and caregiver background check (WI Act 27), driver's license and record check, and payor credentialing. My employment will be contingent upon the information received.

By submitting my applicant materials, I confirm that I have read, understand and agree to the above statements.