RESUME TRACKING FORM

Applicant Information
Received Date: Resume Attached YES NO
Applicant Name:
Degree Level
Department Experience: Administration Clinical Quality Improvement
Program Experience: CCFA Core IFI Substance Abuse Wrap

Contact Log
Date Type of Contact Reason outcome Initial

Telephone Screening–Initial Screening

1. What type of experience have you had working with families in mental health and substance abuse? How many years of
experience of you have?

2. Are you available to work flexible hours including evenings and weekends?

3. Are you comfortable handling crisis situations?

4. Describe your educational background & experience?

5. Describe your documentation skills and the types of documentation cases that you have experience in completing.

6. Not to limit you or commit you to a certain dollar figure, what is the minimum rate per hour you would consider right
now to accept a position.

7. Are you willing to complete drug test, criminal & educational background checks, reference checks, & others as
appropriate for this position?
YES NO
Interview

Is the applicant eligible for an interview? YES NO Interview date and time?
If no, why? After interview complete candidate recommendation form and forward to the next interviewer.

Reconsider this applicant at a later date? YES NO

File in the HR/Contract Management file in the resume file in the admin or clinical folder.

JCCS HR/CM Forms Candidate Screening Form