Initial Pre-Hire Questionnaire for clinic manager candidates

Job Title: Clinic Manager
Applicant's Name:
Company: Aegis Medical Systems, Inc.
Date:
Phone Number:
Email Address:

Aegis Medical Systems, Inc. is the largest network of outpatient Narcotic Treatment Programs (NTPs) in California. We currently staff over 300 employees and are growing rapidly. If you are looking for a professional, challenging and team oriented work environment, please complete this questionnaire and submit it by clicking on the button below..

Your response on this questionnaire will help us better determine your qualifications for this position. Please do not misrepresent yourself.  Employers value honesty and understand that an applicant rarely fits a job perfectly.

Directions: Click on the checkbox next to the statement that best describes how well you meet a requirement and provide an explanation below of exactly how you meet that requirement.


1.   Proven leadership skills. Creative and critical thinking.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    2.   Management experience, over 5-10 years, supervision of 8 or more employees.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    3.   Experience in medical, mental health or social services.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    4.   Organizational skills. Detail and result orientation.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    5.   RN, BA, BS or higher academic degree.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.


  • Explanation:


    6.   2+ years tenure in each previous position.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    7.   Previous experience with regulatory compliance.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    8.   Business orientation.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:


    9. Strong social skills and customer service.

  • I fully meet or exceed this requirement as written. The reasons are stated below.
  • I fully meet this requirement - not exactly as written, but for an alternate reason stated below.
  • I mostly meet this requirement for the reason stated below.
  • I partially meet this requirement for the reason stated below.
  • I do not have the experience, knowledge, or skill specified for this requirement.

  • Explanation:







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