People Living with HIV Stigma Index

People Living with HIV Stigma Index

Interviewer Job Application Form

People Living with HIV Stigma Index Interviewers

Target: 35 interviewers to complete up to 15 interviews each between December 1, 2016 and April 30, 2017

Expected Commitment: 2 days of paid training and up to 15 90-minute interviews (reimbursed with a stipend)

Job Requirements

MUST be a person living with HIV
Working phone number
Able to work legally in the United States
High school diploma (basic reading/writing skills)
Computer skills
Driver’s license (as applicable to the setting in which the individual will work)
Prior research experience preferred
Time management skills

Hiring Process

Complete a job application
Submit personal resume
Conduct a mock interview (i.e., lead 1 short interview)

Contact

Ann D. Bagchi, (201) 303-6101,
Dwight Peavy, (973) 485-5220,

Name: ______Email: ______

Preferred phone number: (______)______-______

Street Address:______

City: ______State: ______Zip: ______

In which areas of the state are you willing to work (mark with an “X” all that apply):

Northern _____Central _____Southern _____

Description of related experience: ______

______

Do you possess a driver’s license that is valid in the state of New Jersey? Yes _____ No _____

Are you a United States’ citizen or immigrant authorized to work in the United States?

Yes _____ No _____

What is your highest educational degree?

High school diploma/GED _____ (Name of school: ______)

Some college/college degree _____ (Name of school: ______)

What languages do you speak fluently? ______

Please provide the names and contact information for two professionalreferences (one of whom should be a case manager or EMA/TGA staff member):

Case Manager Name: ______

Phone number: (______) ______-______

Email address: ______

Reference #2 Name:______

Phone number: (______) ______-______

Email address: ______

Are you 18 years old or older (If under 18, you will be required to submit working papers if offered employment.)  Yes  No

9a. Do you possess a driver’s license that is valid in New Jersey  Yes  No 9b. Do you possess a Commercial Driver License  Yes  No

(Answer these questions only if it is a requirement as indicted on the job announcement or job specification.)

10. Are you either a U.S. citizen or an alien authorized to work in the U.S.  Yes  No

11. Have you ever been convicted of a crime which has not been expunged by the Court  Yes (If yes, give details in Block Number 16) )  No

(A conviction will not necessarily preclude you from employment.)

12. Are you a Veteran  Yes  No

*If yes, have you established Veteran’s Preference with the New Jersey Department of Personnel after April 1, 1980  Yes  No

13. Are you now or have you ever been a member of any Public Employee’s Retirement System  Yes*  No

(If yes, indicate system name and membership number in Block Number 16.)

14. Have you ever worked or been employed under a different name  Yes (If yes, specify here: ...... )  No

15. Are you currently on a special or regular reemployment list, or any list resulting from an examination administered by the New Jersey Department

of Personnel

 Yes*  No * (If yes, indicate Titles and Symbols here:)

......