Summer Quest Agreement & Leadership Application Packet

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

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 from May 15 – August 4, 2023.

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)

Leadership Application

Leadership positions you would like to be considered for:

(check only those you are specifically interested in)

What qualities do you see as your strengths and which would be areas of improvement for you to strive for?

What goals would you set for yourself regarding professional growth if you were chosen for a leadership position?

How do your actions at work and away from work impact the agency and its stated mission/purpose?

How does social media factor into this concept?

Why is this important to the agency?

Bob Nelson has said “You get the best efforts from others not by lighting a fire beneath them, but by building a fire within them.” What tools do you see necessary to “build a fire within” any staff that you may potentially lead?

Assume that you are placed in a leadership position. How would you respond to the following scenarios (be specific)?

You have a staff member in your group who started off excited about his position with the program. Over the past week, you have noticed he has become more withdrawn from the group and when he is interacting, he engages in power struggles frequently with the patients. Please be specific in how you would address this?

It is Wednesday and you have been informed that a new patient is assigned to your group and will start on Monday. You have heard from multiple sources, including staff, that she is very difficult to manage as she is at times physically aggressive towards her peers and staff, frequently off task, and oppositional to redirection. How would you prepare for this new patient?

If you were to nominate a co-worker for a leadership position, who would it be, what position, and why? (be specific as to why they would make a candidate for the position you circled above)

If you were to nominate a co-worker for a leadership position, who would it be, what position, and why? (be specific as to why they would make a candidate for the position you indicated above)

Name

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