Employment Pre-Screening Questionnaire

First Name

Last Name

Phone

Link to CV/LinkedIn

Date Available to Start

Position you are interested in

Tell me about your work experience related to the position in which you are applying:

CCHS requires that all employees to be fully vaccinated. Can you provide evidence to support your vaccination status?

Yes

Are you willing and able to travel?

Yes

What are you looking for in your next role?

What type of work environment are you looking for?

Which management style makes you feel more supported?

What is your salary expectation?

Why are you leaving your current employer?

If leaving previous employer for full-time work, please ask the following: What about full-time work that appeals to you?

Number of Hours available to work

Benefits Eligible

Paid Time Off

Other

N/A

If you are applying for case management, please advise if you have a valid driver's license.

Yes

N/A (Not applying for case management)

If you are applying for a case management position, please advise if you have your own car that is registered and insured.

Yes

N/A (not applying for a case management position)

Are you interested in working after school hours (3:30), Summer hours (full day or half day), and/Saturday (full day or half day)?

Do you have any questions for the hiring manager or HR that I can relay prior to your interview?

Upload Resume

Upload File (PDF Preferred)

Upload supported file (Max 15MB)

Thank you! We’ll be in touch.

4900 Wyalusing Avenue
Philadelphia, PA 19131

Tel: 215-473-7033