Consultant Inquiry Form

Questions marked with a * are required

90%

Contact Information

First Name

Last Name

Phone

Email Address

What is your current employment status?

I am an independent contractor

I am a consultant but working with a firm

I am employed in a non-consulting role

I am between jobs, exploring options

I am retired and considering some professional opportunities

Other

What is your availability to take on a consulting or advisory opportunity?

I am available now for whatever is needed

I have some time available now but am also partially engaged with other obligations

I expect to be available for work soon and am exploring options

I am currently engaged but am interested in getting acquainted with SSX Strategic Staffing for potential opportunities down the road

In which segments of the healthcare industry do you have experience?

What are your main areas of expertise?

	Primary Expertise	Experienced	Some Experience	Minimal Exposure
Executive leadership	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Strategy and product	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Marketing and communications	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Finance	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Healthcare technology	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Data and analytics	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Market research and intelligence	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Operations	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Clinical programs	Primary Expertise	Experienced	Some Experience	Minimal Exposure

Healthcare delivery	Primary Expertise	Experienced	Some Experience	Minimal Exposure

In what kinds of roles would you feel comfortable performing?

Interim C-Suite executive

Interim leader - VP / Director

Executive coach

Program leader - big initiative

Project manager - mid-sized initiative

Business analyst

Research analyst

In which categories are you able to provide a reference for your work?

Former or current boss or supervisor

Former or current colleague or peer

Former or current client

Former or current employee (someone who reported to you)

What is your primary interest for work through Spring Street Exchange Strategic Staffing?

What makes you tick? What is your secret sauce, or the part of your work that reflects you in your best light?