Name
*
First Name
Last Name
Email
*
1. Values
*
MHI is a social enterprise that operates as a values-based organization. Of the values listed below, please select the most resonant:
1.1 Example
*
Tell us a story. Was there a time when you made a values-based decision? Please include the outcome (<200-words)
2. Category
*
MHI wishes to understand what kind of work you are looking for (check one that applies)
If Other, please specify:
3. Service Offerings
*
Which of MHI’s service offerings are you most interested in? (check all that apply, items with a + sign signify a skill/experience)
4. Workplace Experience
*
In which of these sectors do you have experience? (check all that apply)
5. Engagement Credibility
*
Which audience do you most identify and have credibility with?
If other, please specify:
6. Experience
*
(check all that apply)
If other, please specify:
7. Language
*
(check only those where you possess full proficiency)
If other, please specify:
8. Compensation
*
What is your current / expected rate of pay?
9. Mental Health Workshops
*
Which is your preferred target audience? (only select audiences of interest)
11.Client/Project List
*
Please supply past and current clients and the project that you worked on? (no more than 5, and within 10 years)
Please provide two references (name, title, organization, phone, email)
*
12. Expertise
*
That applies to mental health (check all that apply)
If other, please specify:
13. About you
*
What is the one thing you want MHI to know about you?
14. Please indicate below who at MHI referred you to this form
*
15. Please indicate below the reason why you were referred to this form
*
