Consultant Survey Opportunities Form

Thank you for your interest in serving as a consultant for The Moss Group, Inc. Please complete this initial assessment of your expertise and skills. This is the first step in TMG's process to determine your interests. Please also attach your resume or CV and send to Michelle Duhart (mduhart@mossgroup.us).

Question Title

* 1. Please provide your contact details below.

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Have you worked in the following settings? Check all that apply.

Lockups

Jails

Prisons

Juvenile Detention

Community Corrections

Tribal

U.S. Military Corrections

ICE Detention Centers

Probation and Parole

Law Enforcement

None of the above

Other (please specify)

Question Title

* 3. Have you worked with the following populations? Check all that apply.

Male

Female

Adults

Juvenile

LGBTI/Transgender/GNC

Medical/Mental Health

Other (please specify)

Consultant Survey Opportunities Form

Question Title

* 1. Please provide your contact details below.

Question Title

* 2. Have you worked in the following settings? Check all that apply.

Question Title

* 3. Have you worked with the following populations? Check all that apply.

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* 4. Please identify additional languages you speak (other than English), including sign language.