Peer Support Specialist Job Application

Peer Support Specialist Job Application — Form Fields

This applications template includes 11 fields. Apply for a peer support specialist position with lived experience, certifications, and availability. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• City, State (text, required)
• Do you have lived experience with mental health or substance use recovery? (dropdown selection, required) — options: Yes, Prefer not to say
• Tell us about your lived experience and what motivates you for this role (long text, required)
• Highest Education Level (dropdown selection, required) — options: High School/GED, Some College, Associate's, Bachelor's, Master's
• Certifications Held (checkboxes, optional) — options: Certified Peer Support Specialist (CPSS), Recovery Coach, WRAP Facilitator, Mental Health First Aid, None yet
• Availability (dropdown selection, required) — options: Full-Time, Part-Time, Contract/Per Diem
• Resume (file upload, required)
• Describe your approach to supporting others in recovery (long text, required)