CARES Recovery Corps Application

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• * Current Employer:
• * Job title:
• * If accepted into the CARES BCOR Ambassador Program, can you commit to providing at least 50 hours of your time volunteering at CARES or at one of our satellite initiatives in Morris and Passaic counties? This is a requirement for the program; transportation is unfortunately not provided.

• *

  What are your available hours? (select all that apply)

  • Monday: 10:00 AM – 12:00 PM
  • Monday: 1:00 PM – 3:00 PM
  • Monday: 4:00 PM – 6:00 PM
  • Tuesday: 10:00 AM – 12:00 PM
  • Tuesday: 1:00 PM – 3:00 PM
  • Tuesday: 4:00 PM – 6:00 PM
  • Wednesday: 10:00 AM – 12:00 PM
  • Wednesday: 1:00 PM – 3:00 PM
  • Wednesday: 4:00 PM – 6:00 PM
  • Thursday: 10:00 AM – 12:00 PM
  • Thursday: 1:00 PM – 3:00 PM
  • Thursday: 4:00 PM – 6:00 PM
  • Friday: 10:00 AM – 12:00 PM
  • Friday: 1:00 PM – 3:00 PM
• *

  Are you available for weekend or evening hours?

  • Yes
  • No
• * What is your definition of recovery?
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• * Why do you want to participate in CARES BCOR Ambassador Program?
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• * What strengths do you have that would be beneficial as a Peer Recovery Specialist?
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• * Do you have any previous experience volunteering, interning, or working with individuals with a substance use disorder? (Please describe)
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• * Once accepted into the CARES BCOR Ambassador Program, there is no guarantee that any individual will receive the total hours towards their certification through CARES. Individuals can be removed from the program if they are not deemed appropriate for our agency or the work our agency provides.

Additional Information

• * What activities/practices do you participate in to support your recovery?
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• * How do you plan on using the Peer Recovery Specialist certification in your life?
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• * What does multiple pathways of recovery mean to you?
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• * What is your view/opinion on harm reduction?
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• * How would you provide services to an individual(s) who does not share the same belief(s) as you?
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• Please list three (3) personal or job related references; Name, Email, Phone.

• * Reference 1
• * Reference 2
• * Reference 3
• * Do you speak any languages other than English? If so, please specify language & fluency.

• * If you are in recovery, what is your recovery date?
• *

  How did you hear about this opportunity?

  • Facebook
  • Instagram
  • LinkedIn
  • Website: Preventioniskey.org
  • At an event
  • Word of mouth
  • Email
  • Other