INDEPENDENT CONTRACTOR APPLICATION Please complete all fields. When completed, please sign/date and email with a copy of your resume to careers@s4kf.org Success 4 Kids & Families 2902 N. Armenia Ave., Ste. 200 Tampa, FL 33607 Office: 813-490-5494 Fax: 813-490-5495 www.s4kf.org
SUCCESS 4 KIDS & FAMILIES, INC. INDEPENDENT CONTRACTOR CASE MANAGER OVERVIEW & ACKNOWLEDGEMENT SUMMARY The Independent Contractor Case Manager (ICCM) is an independent contractor position providing client support through Success 4 Kids & Families, Inc. (S4KF s) system of wraparound facilitation, support services, and case management to at risk children and their families. QUALIFICATIONS EDUCATIONAL & PROFESSIONAL EXPERIENCE Bachelor s degree from an accredited university or college with a major in counseling, social work, psychology, criminal justice, nursing, rehabilitation, special education, health education, or a related human services field (a related human services field is one in which major course work includes the study of human behavior and development) and have a minimum of one year of full time or equivalent experience working with children with serious emotional disturbances; or Bachelor s degree from an accredited university or college and three years full time or equivalent experience working with children with serious emotional disturbances. PROFESSIONAL SKILLS Effective skills in family coaching, needs assessment, and the ability to help families communicate and work together more effectively. Excellent written and verbal communication skills. Proficiency with basic computer and word processing skills. Ability to build and maintain the community s trust for S4KF as an effective, expert and compassionate provider of service. Ability to develop a comprehensive and in-depth understanding of internal and community programs and services available to clients. Effectively collaborate with S4KF staff and community resources (professionals, paraprfessionals, programs) to assure effective services are provided to all clients. SERVICE EXCELLENCE STANDARDS Adhere to S4KF practice standards for case management by providing effective case management services based on needs and desires of individual clients. Adhere and comply with S4KF operational policies and procedures, funder requirements, acceptable professional standards, and all applicable federal, state and local laws and regulations. Demonstrates commitment to maintaining S4KF s high quality service standards. Provide effective professional services to clients while ensuring strict confidentiality of client information. Meet monthly with designated Program Manager to review all cases. Required to complete a minimum of 20 hours annual continuous education. BACKGROUND REQUIREMENTS Able to provide proof of passing the Department of Children & Families Level II Background Screen Must have a valid Florida Driver s License, good driving record, proof of insurance and reliable transportation. Able to produce verification as a registered LLC in Florida
SUCCESS 4 KIDS & FAMILIES, INC. INDEPENDENT CONTRACTOR CASE MANAGER Although the ICCM operates under the oversight of a Program Manager and/or Clinical Supervisor the ICCM position is an independent contractor position and not an employee of S4KF. As an independent contractor ICCM s; Determine the number, type and geographical region of cases to accept. Schedules the dates and times for client interactions and meetings. Manage and are responsible for expenses incurred including, but not limited to; transportation (vehicle, fuel, tolls, vehicle maintenance), computers, phone, and other ancillary supplies. Is solely responsible for all federal and state tax liabilities associated with being a selfemployed independent contractor. This document is not an offer and/or authorization to be an Independent Contract Case Manager. If offered the opportunity to be an ICCM with S4KF individuals will be required to sign the Success 4 Kids& Families, Inc Standard Independent Contract Agreement for Professional, Technical, or Contractual Services and provide verification of LLC status within the state of Florida. ACKNOWLEDGEMENT: I have read, understand and confirm that I can meet all the duties, responsibilities, requirements, and expectations required for being an Independent Contract Case Manager. I further acknowledge that this is not an offer of employment or a promise to be offered work as an independent contract case manager but an acknowledgement of my request to be considered for approval as an Independent Contract Case Manager.
Success 4 Kids & Families, Inc. 2902 N. Armenia Ave, Suite 200 Tampa, FL 33607-4602 INDEPENDENT CONTRACTOR APPLICATION CONTRACTOR INFORMATION Last Name First M.I. Date Street Apartment/Unit # City State ZIP E-mail Have you ever been employed by S4KF? YES NO If so, when? From: To: Have you ever worked for S4KF as a contractor? YES NO If so, when? From: To: Referred by: BUSINESS INFORMATION All contracted case managers must be registered (LLC/LLP or corporation) to do business in the state of Florida. Name: Registration # I am not currently registered as a business in Florida but understand I must establish myself as an LLC, LLP, or corporation prior to being issued cases. PREVIOUS EMPLOYMENT (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH MOST RECENT EMPLOYER) Job Supervisor Email From: To: Reason for Leaving Job Supervisor Email From To Reason for Leaving Job Supervisor Email From: To: Reason for Leaving Contractor Application Nov 2014
Success 4 Kids & Families, Inc. 2902 N. Armenia Ave, Suite 200 Tampa, FL 33607-4602 INDEPENDENT CONTRACTOR APPLICATION EDUCATION Education please provide all relevant information relating to earned BA, BS, or Master degrees College City/State College City/State Other Professional Licenses / Certifications: Languages Spoken: English Spanish Other (Please list): CRIMINAL BACKGROUND CLEARANCE Pursuant to FL Statute Chapter 435, S4KF, Inc. requires all applicants to pass FDLE Level II and Local criminal background Checks. DCF Level II & Hillsborough County Sheriff s Office local clearance letters must be received by S4KF, Inc. before cases can be assigned to a contractor. Have you ever been convicted of a misdemeanor or felony crime? NO Initials YES (if yes on an please give brief description.) Prior convictions are not an automatic disqualification from consideration. REFERENCES Please provide three professional references. If three previous employers are listed above, please provide a supervisor from each employer. If you have had fewer than three previous employers, please provide volunteer or internship supervisors or educators from a college program. Years Acquainted Years Acquainted Years Acquainted DISCLAIMER AND SIGNATURE I certify that the information I have provided is true and complete to the best of my knowledge. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company from all liability for any damage that may result from utilization of such information. Signature Success 4 Kids & Families, Inc. is an equal opportunity contractor and does not discriminate based on race, religion, gender, national origin, age, disability, political affiliation or belief. Date Contractor Application Nov 2014