Summer Quest Agreement

Forms for Summer Quest Staff - Complete all fields. The forms are considered incomplete unless you hit the submit button at the end.

Name

This field is for validation purposes and should be left unchanged.

Contact Information

Name(Required)

First Middle Last

Phone(Required)

(###) ###-####

Email(Required)

Review the Quest Program Guidelines and initial each item below, indicating that you have read and understand the expectations of each one of these.

If you have any question or hesitations with this document, please contact Tyler tcox@fourcounty.com or Lily lmelle@fourcounty.com before initialing the listed items.

Summer Program Conditional Offer Agreements

Required Agreements

Initial

I acknowledge that this form is a “Conditional Offer of Employment” based on my ability to successfully complete the pre-hire requirements of the agency.

Initial

I understand that this Conditional Offer of Employment is for a “Temporary/Seasonal” position and that this job requires a 13 - week commitment.

Initial

I understand that I am expected to be available for the dates listed, unless prior approval for time off has been granted by a program coordinator.

Initial

I agree to the dress code policy.

Initial

I agree to the cell phone policy.

Initial

I agree to the driving requirements of the position.

Initial

I have thoroughly read through and understand the Job Description, Program Guidelines, and I understand the requirements of the position.

Initial

I further understand that I must notify Four County Mental Health of any restrictions that would prohibit me from performing the functions of the job, changes to my status, or place myself or those I am working with in harm’s way.

Optional Agreements

Initial

I have a personal vehicle and a valid driver’s license that I would be willing to use for program needs and understand I will be reimbursed for mileage at the current agency rate. (Only initial if you have a personal vehicle that you are willing to use.)

Initial

I am available to provide 1:1 Attendant Care Support in the afternoons, early evening hours Mon-Friday (only initial IF you have a personal vehicle AND desire to have additional hours. These hours are not guaranteed but provided based on patient need).

By signing my name below, I acknowledge that I have read, understand, and agree to the information outlined above.

I understand that I am held responsible to uphold my commitment to the above mentioned items. By electronically signing below, I acknowledge that I will be held to the expectations of the position as outlined above.

Applicant Signature(Required)

Date(Required)