Personal Information Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Can you submit verification of your legal right to work in the United States? Yes No Have you ever been employed at Charles R. Drew University of Medicine and Science? Yes No Do you have a valid California Drivers License or Identification Card? Yes No Can submit verification of vaccination (including COVID-19)? Yes No Do you fluently read, speak or write a language other than English? If yes, please explain. Have you ever been dismissed or asked to resign from a position? If yes, please explain. Can you perform the essential duties of the position with or without a reasonable accommodation? Yes No Supplemental Questions How did you hear about this employment opportunity? Public Job Posting Internal Job Posting Agency Referral Advertisement/Publication Personal Referral Website Indeed Other Do you have a regionally accredited bachelors degree or an equivalent of combined education and related work experience? Yes No Do you have the following: strong organizational skills, detail-oriented, ability to work well with other in a clinical or community setting? Please describe. Please describe your experience working with Black birthing families. Do you have experience with the CenteredPregnancy model or facilitating group prenatal sessions? If yes, please explain. Yes No This position requires the facilitator to conduct sessions within the Antelope Valley. Can you confirm you live in or have reliable transportation to travel to the Antelope Valley to participate in training and to facilitate sessions? Yes No References Please list 3 professional references. Include at least one supervisor. Name First Name Last Name Email Phone (###) ### #### Company Current Job Title Name First Name Last Name Email Phone (###) ### #### Company Current Job Title Name First Name Last Name Email Phone (###) ### #### Company Current Job Title Thank you! We have received your application. Please send a copy of your resume to bmhce@cdrewu.edu Application: Group Prenatal Facilitator (Antelope Valley)
