Innovative Excellence Candidate Questionnaire

"Real Leaders Are Ordinary People with Extraordinary Determination"

INNOVATIVE EXCELLENCE, LLC supports the Interim Candidate needs for multiple organizations and clients.

If Interim Leadership is a current interest of yours, please complete the following questionnaire. This information will provide an initial approach toward matching your interests and requirements with the specific needs of our healthcare clients.

Section #2 below allows you to upload your current resume. If there are any issues with this process, it can also be emailed directly to nita@innovativeexcellence.net.

Once we have all of this information, either myself or a Search Consultant will contact you to ensure we are on the same page. We will then aggressively seek to bring new job opportunities your way.

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* 1. Address

Name

Email Address

Phone Number

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* 2. Please attach your current resume / CV

PDF, DOCX, JPEG, JPG, DOC file types only.

Choose File

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* 3. Please list your current areas of EXPERTISE for Interim Leadership roles:

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* 4. Level of Interim Leadership role that you are qualified for and would be willing to consider:

• CEO / COO

• CNO

• Vice President

• Director / Administrative Director

• Manager

• Supervisor

Other (please specify)

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* 5. Define areas of the country where you would consider accepting an Interim Opportunity (include areas of preference)?

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* 6. If you are an RN, please identify the states where you are currently licensed.

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* 7. When will you be available to assume an Interim Assignment?

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* 8. Please outline any additional information that you would like to share regarding your interest in Interim Leadership.

As mentioned, once we have all of this information, we will contact you to ensure we have a clear understanding of your overall areas of interest and hopefully provide future interim opportunities that may be a fit with your areas of expertise and timing.

Thank you for your kind consideration. Feel free to contact me if you have questions or concerns.

Regards,

Nita

Nita Kasan
President / CEO
Innovative Excellence, LLC
239-537-9618
800-886-7702 (fax)
nita@innovativeexcellence.net
www.innovativeexcellence.net