1801 N. Tryon Street

1801 N. Tryon Street

Charlotte, NC 28206

(704) 612-0556 – office

(704) 498-4846 - fax

Dear Candidate of Employment,

It is my pleasure to welcome you to Alternative Living Solutions. I am excited that you have chosen to become a member of the Alternative Living Solutions Medical Outreach Team. Enclosed you will find a request for employment packet that must be completed before further consideration is rendered.

The following checklist shall be used as a way to ensure that all documentation is collected and submitted.

• Completed Medical Outreach Application
• Updated copy of Resume (required) & Cover Letter (if desired)
• Proof of Professional certifications and/or designations
• Transcript of all completed Post High School Education
• Certificate of Understanding for Medical Outreach Specialist requirements

***These items must be included, so that your application will be considered complete. If your application is submitted without the requested items, your application will be held for 15 business days, and then discarded on the 16th business day, at that point you will need to begin your application process over.

Once again thank you for your interest in employment with Alternative Living Solutions. I look forward to speaking to you more about the Medical Outreach Specialist opportunities with Alternative Living Solutions.

Sincerely,

Cheryl L. S. Richardson

Cheryl L.S. Richardson

Executive Director

POSITION FOR WHICH
YOU ARE APPLYING:
Check all that you may be interested in: Full-Time Part-time
Last Name / First Name / Middle Initial
Mailing Address / City / Apt #
State / Zip / Cell Telephone No. / Home Telephone No. / Business Phone No. / E-Mail Address
Driver’s License # / State / Expiration Date / Operators (Private Vehicle)
CDL (copy needed of
license & medical card) / License Class
Endorsement
Are you a Veteran? If yes, please list Branch, Time Served and Type of Discharge / Yes No
Have you ever been convicted of a felony? If you answered yes, please complete the following: (Conviction is not an automatic bar to employment. Each case is considered on its individual merits).
Nature of OffenseName & Location of CourtDate of Conviction / (Inaccurate information here will result in disqualification.)
Yes No
Have you ever been discharged or forced to resign from any position? If yes, please give employer, date and reason.Employer Date and Reason / Yes No
If hired, are you authorized to work in the United States? For non citizens, a copy of your authorization to work issued by the U.S. Immigration and Naturalization Service must be submitted prior to appointment. / Yes No
References / For Office Use Only:
Date and Time Received
Accepted by: [ ]
Name / Telephone Number

1801 N. Tryon Street

Charlotte, NC 28206

(704) 612-0556 – office

(704) 498-4846 - fax

EDUCATION AND TRAINING

High School Education, Training and PostHigh School Education
Highest Grade Completed (choose one)
1 2 3 4 5 6
7 8 9 10 11 12 / Did you graduate from High School or obtain a GED?
YES NO / Name and Location of LastSchool Attended
Name: ______
Location: ______
RELATED SPECIAL TRAINING (CORRESPONDENCE, BUSINESS, TRADES, VOCATIONAL, ARMED FORCES SCHOOLS, ETC.)
Names and Locations of School / Dates Attended (Mo & Yr) / Courses/Subjects Completed / Credit Hours / Diplomas/Certificates
Received
From / To
COLLEGES AND UNIVERSITIES ATTENDED (UNDERGRADUATE & GRADUATE)
**Must be from a recognized accredited school - Bring official transcript with initial application**
Names and Locations of School(s) / Dates Attended (Mo & Yr) / Credit Hours / Type of Degree Earned (e.g.BA/BS) / Major / Minor
From / To / Semester OR Quarter
Major Undergraduate
College Subjects / Credit Hours / Major Graduate
College Subjects / Credit Hours
Major Undergraduate
College Subjects / Credit Hours / Major Graduate
College Subjects / Credit Hours
Semester OR Quarter / Semester OR Quarter
RELATED LICENSES (provide original)
Professional License Issued By / Field/Trade Specialization / License Number / Issue
Date / Expiration Date
SKILLS
Excel/Lotus
Typing
wpm
Access
Word
ORACLE
PowerPoint
Other software
Languages spoken and written FLUENTLY:______
Also include specific software experience in your job descriptions: ______
Ask about PC skills exams and provide certificates of courses completed: ______
EMPLOYMENT HISTORY
May we contact your present employer? YES NO
1 / Starting Date
month / day / year / Ending Date
month / day / year / Employer/Company Name and address (city and state are required)
Paid Work
Volunteer/ Internship / Hours per Week / Name & Title of Immediate Supervisor / Telephone Number
Reason for Leaving
Title of Position Held / Number & Job Title of Employees you Supervised
Describe job responsibilities in order of importance:
2 / Starting Date
month / day / year / Ending Date
month / day / year / Employer/Company Name and address (city and state are required)
Paid Work
Volunteer/ Internship / Hours per Week / Name & Title of Immediate Supervisor / Telephone Number
Reason for Leaving
Title of Position Held / Number & Job Title of Employees you Supervised
Describe job responsibilities in order of importance:
EMPLOYMENT HISTORY CONTINUED
May we contact your present employer? YES NO
3 / Starting Date
month / day / year / Ending Date
month / day / year / Employer/Company Name and address (city and state are required)
Paid Work
Volunteer/ Internship / Hours per Week / Name & Title of Immediate Supervisor / Telephone Number
Reason for Leaving
Title of Position Held / Number & Job Title of Employees you Supervised
Describe job responsibilities in order of importance:
4 / Starting Date
month / day / year / Ending Date
month / day / year / Employer/Company Name and address (city and state are required)
Paid Work
Volunteer/ Internship / Hours per Week / Name & Title of Immediate Supervisor / Telephone Number
Reason for Leaving
Title of Position Held / Number & Job Title of Employees you Supervised
Describe job responsibilities in order of importance:
CONDITIONS OF EMPLOYMENT STATEMENT
Under penalties of perjury, I declare that my answers to the questions on this application and any necessary examinations and supplements are true and give Alternative Living Solutions the right to investigate all information given and to secure additional appropriate information if necessary. I understand that an investigative report may be made from information obtained through personal interviews with others. I understand that this inquiry may include information as to my personal characteristics, employment verification, credential verification, personal identity verifications, reference checks, criminal records, motor vehicle records, and appropriateness for employment. In accordance with the law and my understanding of this statement, I authorize my current and former employers to give any information regarding my employment, together with all information regarding me, and hereby release from all liability or responsibility all persons, companies, or corporations furnishing such information in good faith. I also authorize the release of my scholastic ratings to the Alternative Living Solutions by schools and other education institutions that I have attended.
I understand that the completion of this application does not assure me of a position with the Alternative Living Solutions does not obligate Alternative Living Solutions to me in any way. I further understand that any misrepresentation herein may cause my application to be rejected, my name to be removed from the eligible register and/or subject me to dismissal. Candidates selected for hire must pass a physical and drug screen prior to employment. I am aware that the results will be made available to the Executive Director or a duly authorized representative. Alternative Living Solutions is committed to a drug free work place to protect the safety of workers and the public and will comply with the Federal Drug Free Work Place Act.
I understand that this application, exam documents and attachments become a part of Alternative Living Solutions records and will not be returned, reused or copied for me once submitted.
By my signature, I certify, authorize and acknowledge the above statements.
Signature / Date / Social Security Number
(Unsigned applications will not be considered)
APPLICANT DATA
The information requested in the following questions will not affect you as an applicant. This information will be used to determine if our recruitment efforts are reaching all segments of the community, to meet federal EEO reporting requirements and to conduct background checks.
Last Name / First Name / Middle Initial
Social Security Number (required) / Date of Birth / Month / Date / Year / Female / Male
Ethnic Origin / Race
Hispanic
or
Latino / Non-Hispanic or
Non-Latino / American Indian/ Alaskan Native / Native Hawaiian or other Pacific Islander
Asian / Black / White

Medical Outreach Specialist

I understand to be considered for the Medical Outreach Specialist position; I must meet one of the following qualifications:

1. Hold a master’s degree from an accredited college or university in a human services field, including, but not limited to, social work, sociology, child development, maternal and child health, counseling, psychology, or nursing, communications or marketing.
2. Hold a bachelor’s degree from an accredited school of social work.
3. Hold a bachelor’s degree from an accredited college or university in a human services field, communications, marketing or related curriculums, including at least 15 semester hours in courses related to social work, counseling, or public health; and have six months of social work or counseling experience.
4. Hold a bachelor’s degree from an accredited college or university and have 1year of experience in counseling or in a related human services field that provides experience in techniques of counseling, casework, group work, social work, public health, or human services.
5. Be licensed, if applicable, by the appropriate licensure board in North Carolina as a registered nurse, nurse practitioner, physician, physician assistant, or certified substance abuse counselor and have two years of experience working in human services.

In addition, the Medical Outreach Specialist must possess 1 year of experience in public speaking or communicating the importance of a product or service. All Medical Outreach Specialist must possess or acquire (upon hire) through cross training a clinical understanding of HIV and become a Certified HIV Counselor, as evidenced by documentation in their personnel file.

** An accredited educational institution is one that is nationally recognized.

Medical Outreach Specialist experience should encompass the functions of education, assessment, prevention and referral. The Medical Outreach Specialist shall possess the following level of expertiseand core competencies:

1. Able to perform the assessment
2. Able to provide referral and linkage to clients serviced
3. Able to provide documentation and attestation as to accuracy of the entry by a personal signature

Knowledge, Skills and Abilities

The Medical Outreach Specialist must possess and demonstrate the following:

1. Basic knowledge of HIV disease, prevention and treatment techniques. The knowledge should be based on current testing/ counseling practice, defined as standards of practice within one year from the date of hire. The basic knowledge shall include: methods of transmission and treatment, common definitions, general knowledge of medications used to treat HIV and barriers to medication and treatment compliance.
2. Communication skills including listening, written, verbal and non-verbal skills
3. Ability to gather information and data, and accurately synthesize into written form
4. Ability to identify resources, both formal and informal
5. Ability to initiate obtaining professional/clinical assessments
6. Ability to assess the cultural environment and to interact in a culturally sensitive manner
7. Prioritization skills including time management skills, planning and organizational skills and professional judgment skills
8. Ability to accurately document case management activities and attest to its accuracy by personal signature.

Statement of Understanding

I have read and fully understand the details of this job description. I further certify that I meet the minimum requirements to be considered for this position.

______

Applicant SignatureDate