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Community Health Worker Application
Kerri
2021-08-23T09:07:24-06:00
CHW Application
Name
*
First
Last
Street Address
*
Address Line Two
City
*
State
*
Zip Code
*
Email
*
Primary Phone Number
*
Secondary Phone Number
Highest level of education completed
*
some high school
high school
some college
college
graduate studies
masters degree
PhD
Are you at least 18 years old?
*
Yes
No
In your opinion, why is it important for members of your community to get vaccinated against COVID-19?
About how many hours per week would you like to work? Are there days and times that will work best for you? We understand your schedule will change from week-to-week. Most people will work 1-10 hours per week, but we are flexible.
We would like to reach as many people as we can, and educate them about the vaccine. What are some ideas you have about groups of people you might reach out to in order to provide education? (Examples might be going door-to-door, talking to people at work, talking to people at a religious setting – we appreciate any good ideas you might have!)
What questions do you have for us right now?
Please upload your Resume or CV here or submit cover letter and resume to:
[email protected]
Accepted file types: pdf, doc, docx, txt, pub, rtf, Max. file size: 64 MB.
List the names and contact information for three references.
If offered employment at SWCAHEC, when would you be available to start?
*
MM slash DD slash YYYY
Would you agree to a background check of your certifications and/or licensure?
Yes
No
Are you eligible for employment in the United States?
Yes
No
How did you hear about this open position
SWCAHEC Pathways Updates
Durango Herald
Through a friend or co-worker
Social Media
First and Last Name (electronic signature)
Date
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.
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