HealthVisions is required to conduct screenings of applicants for the Certified Community Health Worker Training.  Please complete the information below and use general terms to maintain the confidentiality of individuals.  Do not provide names, addresses, etc.

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* 1. Self-Awareness and Understanding

How do you ensure that your experience and biases don't negatively affect your relationships with clients and colleagues?

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* 2. Interpersonal Warmth

Give an example of a time when you listened with compassion and kindness.

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* 3. Trustworthy

Give an example of a time when you demonstrated that you were trustworthy, able to maintain confidentiality and uphold professional ethics.

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* 4. Teamwork and Problem Solving

Describe a project when you involved others; how did you overcome challenges?

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* 5. Communication

What is your approach to effective communication with others?

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* 6. Open mindedness

Describe a time you embraced another person's differences without being judgmental in your interaction with the person.

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* 7. Psychological Health

How do you practice self-care to maintain emotional and mental health?

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* 8. Objectivety

Describe a time when you had to show objectivity without showing your bias.

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* 9. Commitment to Social Justice

How have you advocated for others, fought against injustice and/or promoted health and well-being of another person or your community?

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* 10. Competence

How do you develop knowledge and skills to serve your community and/or clients?

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* 11. Sensitivity

How do you show respect for the opinions, feelings, experience or culture of others that are different from yours?

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* 12. How will you use the CCHW Training to serve your community?

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* 13. What are your career goals as a CHW and beyond?

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* 14. Describe the skills you believe you have to be a successful CCHW.

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* 15. Describe your previous work experience and/or education

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* 16. Why do you want to be a CCHW and why do you think you will be good at it?

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* 17. Please complete the following information.

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