NYC Health IT Ops/PMO Director Health IT Questionnaire

General Candidate Information
Name
Where do you live?
Are you a US citizen?	Yes No
Do you require corporate sponsorship to work in the United States?
Please indicate your highest level of educational achievement (BA, MA, MBA, PHD, etc.)
Office Telephone Number
Home Telephone Number
Cellular Telephone Number
Email Address
Have you ever directly or indirectly (through a recruiter) approached or interviewed with for the role identified in this Questionnaire:	Yes No
If yes when:
Directly or through a recruiter:
Do you authorize RC Search to present your candidacy for this opportunity to ?	Yes No

Reasons For A Career Change
Are you currently employed?	Yes No
If so, at which company?
Why are you considering leaving your current company? (If you already left your most recent company -- when and why?)


Experience:
How many years experience do you have
in an Ops/PMO Director role
developing and executing on client, staff and technology plans that include web and customer relationship management environments
with business analysis
with workflow design
with Microsoft CRM
in the Health, Wellness and or Fitness Industry
with Program Management/Planning & Strategy
delivering projects on time
mapping business requirements into project specifications
managing to performance metrics and using analytical skills to build tools to measure
managing people across roles (It, Clincal)
working in a high growth entrepreneurial environment
with call center technology.

Compensation History
What is your current or most recent base salary?
What were your W2s in	2014
	2013
	2012
Are there any additional compensation history comments you wish to share?
Please provide the name of the RC Search Co-Recruiter with whom you have spoken about this opportunity:
How did you find out about this opportunity?
Referring Friend or Colleague

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