Wufoo
Community Health Worker Apprenticeship
Application for the 2023 cohort is currently closed. You can still fill out this form for the next cohort in 2024.
Apprenticeship Information.:
PAID 6-MONTH COMMUNITY HEALTH WORKER TRAINING (VIRTUAL AND IN-PERSON)
TIME COMMITMENT: 20 HOURS/WEEK, $1800 MONTHLY STIPEND
Program includes:
-Community Health Worker courses provided by the Alameda County Health Coach Apprenticeship Program and Chabot College
-Professional skills training & Career Coaching with DHTI
-Paid Externship & One-Time Transportation Gift Card Provided
Hybrid Training Model:
-75% of classes held via ONLINE
-remaining 25% held In-PERSON at 1000 San Leandro Blvd, San Leandro, CA
Requirements
-High school diploma/equivalent or GED
-Motivated individual with compassion, with the right attitude and appreciation.
-Must be able to pass a background check and medical clearance.
๐๐ฅ๐๐๐ฌ๐ ๐๐จ๐ฆ๐ฉ๐ฅ๐๐ญ๐ ๐ญ๐ก๐ ๐๐ฉ๐ฉ๐ฅ๐ข๐๐๐ญ๐ข๐จ๐ง ๐๐จ๐ซ๐ฆ ๐๐๐ฅ๐จ๐ฐ. ๐๐๐ญ๐๐ซ ๐ฒ๐จ๐ฎ๐ซ ๐๐ง๐ฌ๐ฐ๐๐ซ๐ฌ ๐ก๐๐ฏ๐ ๐๐๐๐ง ๐ฌ๐ฎ๐๐ฆ๐ข๐ญ๐ญ๐๐, ๐ฐ๐ ๐ฐ๐ข๐ฅ๐ฅ ๐๐ฌ๐ฌ๐๐ฌ๐ฌ ๐ฐ๐ก๐๐ญ๐ก๐๐ซ ๐ฒ๐จ๐ฎ ๐ฐ๐ข๐ฅ๐ฅ ๐ฉ๐ซ๐จ๐๐๐๐ ๐ญ๐จ ๐๐จ๐ฆ๐ฉ๐ฅ๐๐ญ๐ ๐ญ๐ก๐ ๐๐ฉ๐ฉ๐ฅ๐ข๐๐๐ญ๐ข๐จ๐ง ๐๐จ๐ซ๐ฆ ๐๐ซ๐จ๐ฆ ๐ฌ๐๐ก๐จ๐จ๐ฅ ๐๐๐ฆ๐ข๐ฌ๐ฌ๐ข๐จ๐ง ๐๐ง๐ ๐ญ๐ก๐ ๐ข๐ง๐ญ๐๐ซ๐ฏ๐ข๐๐ฐ, ๐ฐ๐ก๐ข๐๐ก ๐๐ซ๐ ๐ญ๐ก๐ ๐ง๐๐ฑ๐ญ ๐ฉ๐ก๐๐ฌ๐ ๐จ๐ ๐ญ๐ก๐ ๐๐๐ฆ๐ข๐ฌ๐ฌ๐ข๐จ๐ง๐ฌ ๐ฉ๐ซ๐จ๐๐๐ฌ๐ฌ.
Name
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First
Last
Email
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Phone Number
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Do you live in State of California?
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Yes
No
Do you hold a specific license to provide clinical care? (such as Registered Nurse, Licensed Physicians. CNA/HHA does not apply.)
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Yes, I am a Regisered Nurse
Yes, I am a Licensed Physician
No, but I am a CNA or HHA
No, I don't have any license or certification in direct care
Are you either working for pay as a direct caregiver or providing long-term unpaid care for an older adult or a person with disabilities?
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Yes
No
Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
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Namibia
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Nicaragua
Niger
Nigeria
Niue
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Norway
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Panama
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Portugal
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Syria
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Vanuatu
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Country
How did you hear about DHTI?
*
DHTI Email
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Referred by Adult School
Referred by Organization Staff
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Other (Please provide details below)
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Birthdate
*
MM
/
DD
/
YYYY
Gender
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Female
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I do not wish to report
Other (Please provide details below)
Maximum of
250
characters.
Currently Used:
0
characters.
Race
*
Asian
Hispanic or Latinx
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I do not wish to report
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Other (Please provide details below)
Ethnicity
*
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Chinese
Hmoob
Indian
Japanese
Korean
Malaysian
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Vietnamese
African American
Jamaican
Haitian
Nigerian
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Other (Please provide details below)
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First Language
*
English
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Other (Please provide details below)
Second Language
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English
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Cantonese
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Burmese
Spanish
Hindi
Arabic
Farsi
Other (Please provide detail below)
Other (Please provide details below)
Legal Status
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Other (Please provide details below)
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For this program, you are required to be authorized to work in the U.S. Do you have authorization? (for example: Social Security Number, green card, work permit, etc.)
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Yes
No
Applied and waiting for approval
Other (Please provide detail below)
Maximum of
250
characters.
Currently Used:
0
characters.
Do you have a valid California driver license and own transportation?
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Yes
No
I am not sure
Do you see yourself as computer literate?
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Yes
No
Are you attending an English as a Second Language (ESL) class right now?
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Yes, I am attending ESL
No, I am not attending ESL classes
What's your highest education?
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Primary School
Secondary School/GED or High School Diploma
Post Secondary Technical School
Undergraduate/Bachelor's Degree
Graduated School/Master's Degree
PhD/Doctoral Degree
Other (Please provide details below)
Other (Please provide details below)
This Apprenticeship is aim to help individual find Community Health Worker job upon completion. How likely would you be able to work in this field in 6 month?
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Very Likely, can work right after completing the training.
Likely, can work within 3-6 months after completing the training
Maybe, if I find a position that's a good fit
Maybe, in 6 months to 1 year.
Not Likely. Not looking for work.
If you are maybe, please indicate reason:
If you are maybe, please indicate reason:
Are you looking for work or in the future?
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Yes, I am looking for work now
Yes, I am looking for work in the next 6 months to 1 year
No, I am not looking for work
Please briefly tell us about yourself; personally and professionally.
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What are your strengths and weaknesses?
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Have you worked in this field or with your community before? Please write your experiences and provide examples.
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Why would you like to pursue a career as a Community Health Worker?
Name a few of your skills that you believe are good assets for a Community Health Worker?
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While completing the program requirements; do you think you would encounter some challenges along the way?
What would be some of those challenges? What would motivate you to overcome those challenges and how would you do it?
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Describe the community(ies) you have been involved with and their needs and expectations.
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How confident are you in using these computer/ internet functions?
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Not confident
A little confident
Confident
Very confident
Use internet to search information
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Send/ reply to an email
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Participate in online class using zoom/ google hangouts
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Use Microsoft Word
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Use Microsoft Excel
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Have you ever been convicted of a felony/crime?
Is there any issues and/or information that we need to be made aware of regarding your personal background or current situation (e.g., history of abuse, criminal record, DUIโS, use of illegal substances, recovery, medical conditions etc...)
If yes, please explain:
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