SMP CHOICES Volunteer Application

CHOICES-SMP Team Member Application
Dear Applicant:

Thank you for your interest in the SMP and/or SHIP (CHOICES) volunteer program. The contents of this application packet are designed to help answer common questions about the program and to provide some information about what you can expect as a volunteer. The SMP/SHIP program missions are accomplished through the valued contributions of volunteers.

The SMP mission is to educate and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, error, and abuse through outreach, counseling, and education.

The SHIP mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling, and training to make informed health insurance decisions that optimize access to care and benefits. In Connecticut, the national SHIP program goes by the name of CHOICES.

The SMP/SHIP carefully selects and places volunteers in positions that match up well with their background, skills, and interests.

Volunteers are essential to the work of the SMP/SHIP program. They provide critical information that assist Medicare Beneficiaries in saving money and receiving optimal healthcare. Volunteers provide administrative support, distribute information, staff information booths at outreach events, presentations, help people who have questions about health care and health care fraud and abuse, and much more. Without volunteers, the program could not function.

The program has high standards for its paid staff and volunteers alike. We aim to provide timely and helpful information, and to answer questions accurately and objectively. The SMP/SHIP supports volunteers every step of the way with thorough training and supervision. They receive orientation and training specific to the skills needed to equip volunteers to feel supported in their roles.

SMP/SHIP volunteers can expect their designated SMP/SHIP Coordinator to provide ongoing support that includes answering questions, providing constructive feedback and direction, and checking in. SMP/SHIP Coordinators strive to give support that relies on positive, constructive, and success-oriented guidance for volunteers as they work to fulfill the SMP/SHIP program’s mission. We want them to have a positive and productive volunteer experience.

The work is challenging, interesting, and ultimately rewarding. If you decide that you want to apply for a volunteer position with the SMP and/or SHIP program, complete the online application form. If you have any questions about the volunteer program or the application and screening process, please feel free to contact the Coordinator. Thanks again for your interest. We look forward to hearing from you.

Sincerely,

The CT SMP and CHOICES Staff

About the Volunteer Application & Screening Process

1.     What are the steps in the application and screening process?

At a minimum, the process requires a completed application form and an interview. Depending on the role, the screening process may also include reference checks, a criminal records check, automobile insurance verification and checks on employment background.

2.     Why are there so many steps in the process?

The SMP and SHIP/CHOICES programs takes seriously the safety of the program’s beneficiaries and volunteers. Many of the people who use the program’s services are in a vulnerable position due to illness, infirmity, and dependence. A thorough screening process enables the program to maintain a safe and productive community service program with trustworthy and reliable volunteers who do not present a risk of harm to themselves and others.

3.     Who reviews my application form?

If you are applying for a CHOICES role, the CHOICES Regional Coordinator will review your application. If you are applying for an SMP role, the SMP Coordinator of Volunteers will review your application. If you are applying to both CHOICES and SMP, both the CHOICES Regional Coordinator and SMP Coordinator of Volunteers will review your application.

4.     Why do you ask about conflicts of interest on the application form?

The SMP/SHIP programs strive to provide objective and unbiased information and services involving Medicare and other health insurance programs. Objectivity is important to building trust with individuals and a reputation of trustworthiness in the community. To build a volunteer workforce that provides objective information and services, we ask applicants to declare if they have a financial, personal, or philosophical interest that may present a conflict with the program’s interest in maintaining its reputation for objectivity.

5.     Why do you check references and conduct a criminal records check (for some positions)?

These types of checks are conducted for volunteer roles that we deem “positions of trust,” meaning they involve access to clients or client personal information (see the SMP/SHIP Volunteer Roles handout included in this packet). We may check at least two personal and/or work references because they provide relevant information for the managers who make the acceptance and placement decisions. We also check criminal records to ensure the safety of SMP/SHIP clients. We will inform you of the screening steps required for the position for which you have applied and conduct them only with your consent.

6.     What will you do with the sensitive personal information that I provide?

We will respect and protect any information that you give us in confidence. We will share the information only with people who have a need to know it.

7.     How will I learn if I have been accepted into CHOICES/SMP New Team Member training?

If we accept you for CHOICES/SMP New Team Member training, we will inform you about attending training. Upon completion of the training, you will be required to complete additional steps in order to become a CHOICES/SMP team member, including demonstrating your understanding of the material through an exam.

8.     How long does the screening process take?

The length of time may vary depending on our ability to schedule an interview, the availability of references to take calls and answer questions, and the response time of authorities who conduct background checks and criminal records checks. The process could take a few weeks. We will update you if the process takes longer than we expect.

9.     How will I learn if I have been accepted as a CHOICES/SMP team member?

In order to become a CHOICES/SMP team member, there are several steps after the screening and interview process, including training, examination, and signing of agreements. You will receive a letter that notifies you of our decision. If we accept you as a CHOICES/SMP team member, the letter will provide you with placement location information. The letter will also include notification of your three-month probation period. If you are not accepted as a team member, you will receive a letter that explains why your service has been declined.

SMP/SHIP Volunteer Self-Assessment of Skills and Interests Directions: view the following list of common roles performed by SMP/SHIP volunteers and rank your top three choices based on your interest in performing each type of work. In the column on the right, use the drop down to select your top three interests. Place “1” next to your top interest, a “2” next to your second highest interest, and a “3” next to your third highest interest. In the column on the right, make a few notes about the reasons that each role interests you. For example, do you have experience in this area?

	Choose top three interests	Why this Role Interests me
Information distributor: This role involves transporting and disseminating information materials to sites and events and may include presenting prepared copy or performing scripted activities for small groups. Volunteers who work in this role do not engage in discussions with others about personal information or situations. It is not considered to be a position of trust.
Administrative support: This role involves such work as copying, filing, data entry, and placing outbound phone calls in support of program activity. Volunteers who work in this role do not take inbound phone calls or field questions from the public. Depending on the nature of the work, this role may be considered a position of trust.
Exhibitor: This role involves staffing information kiosks or exhibits at events such as health fairs. Volunteers who staff exhibits provide general information about the program to the public and answer basic questions. It is a position of trust.
Presenter: This role involves giving substantive presentations to small and large groups, with the opportunity for interaction with the audience during time set aside for Q & A and discussion. It is a position of trust.
Counselor: This role involves direct discussion with beneficiaries, caregivers, and/or family members about their individual situations and may include review of personal information such as Medicare Summary Notices, billing statements, and other related financial and health documents. It is a position of trust.
Open Enrollment Counselor (CHOICES/SHIP only): This role involves assisting Medicare beneficiaries and their caregivers during the annual Medicare Open Enrollment Period. Open Enrollment Counselors provide assistance with plan comparisons and enrollments into Medicare Part D or Medicare Advantage Plans. Counselors may also conduct eligibility screenings and provide application assistance for other Medicare related benefit programs. Team members who serve in this role may act on behalf of a beneficiary to correct an error or refer the beneficiary to other agencies. It is a position of trust.
Complex interactions specialist (SMP only): This role involves in-depth, complex interactions with beneficiaries, caregivers, and/or family members who are reporting specific instances of health care fraud, errors, and abuse. Volunteers who serve in this role may act on behalf of a beneficiary to correct an error or refer suspected fraud and abuse to appropriate authorities. It is a position of trust.
Other

Volunteer Application

Team Member roles are open to community members regardless of race, religion, color, national origin, gender, gender identity, sexual orientation, ancestry, mental or physical disability, medical condition, political activity, marital status, or age.
Select which program(s) you are applying for:*
Select the Area Agency on Aging you are volunteering with:*

Applicant Contact Information
Applicant Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address where you will be performing your work (if known):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Primary Phone*
Please enter a valid phone number.
Applicant Other Phone
Please enter a valid phone number.
Applicant Email
example@example.com
Best method to reach you*

Emergency Contact Information
Emergency Contact person name*
Relationship
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.

Applicant Information
Race
Please list languages you are fluent including Sign language:
Work/Volunteer Experience

Please tell us about your work experience, including paid and volunteer positions. If you are currently employed, please list your current job first. Use the remaining spaces to describe other work experiences (paid or volunteer) that relate in any way to the SMP/CHOICES volunteer position.
Job/Experience 1*

Organization Name

Position/Title

CityState / Province

Type of Work
Type of work
Time period at Job/Experience (i.e. 2001-2007)
Job/Experience 2

Organization Name

Position/Title

CityState / Province

Type of Work
Type of Work
Time period at Job/Experience (i.e. 1980-1995)
Job/Experience 3

Organization Name

Position/Title

CityState / Province

Type of Work
Type of work
Time period at Job/Experience (i.e. 1972-1985)
Please describe any skills or experience that would enable you to perform the duties of a volunteer.
Do you require any special accommodations that the SMP/CHOICES coordinator should be aware of? If yes, describe in space below. If no, please write n/a.*
Are you licensed and able to drive an automobile?*

YesNo
If you will be driving to and from events or to conduct outreach activities, you will need to provide a copy of your driver's license and proof of insurance. We will collect this information at a later point in the screening process.

Conflicts of Interest
Certain conflicts between personal interests and the interests of the SMP/CHOICES program may exist and could prevent a person from serving as a volunteer. No person who has a conflict of interest in connection with the work they will do under SMP/CHOICES, whether personal, philosophical, or financial may serve as a volunteer. Volunteers do not promote any personal or business interest while performing SMP/CHOICES work. One example of persons with an inherent conflict of interest is anyone who receives compensation for enrolling beneficiaries in a specific insurance plan or plans. Some conflicts of interest, however, can be addressed in other ways and may not prevent someone from serving with the program.
If you have a business or other personal interest that may create a conflict, please describe it here so we can discuss it fully during your interview.*

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CHOICES-SMP Team Member Application

About the Volunteer Application & Screening Process

Volunteer Application

Applicant Contact Information

Emergency Contact Information

Applicant Information

Conflicts of Interest

Interest in the SMP/CHOICES Program

Authorization and Certification

References