EMPLOYEE CHECK LIST

() COPY OF DRIVERS LICENSE AND COPY OF SSN #

() EMPLOYMENT CONFIRMATION
() RESUME
() APPLICATION & CRIMINAL RECORD STATEMENT
() CREDENTIAL/CERTIFICATION/REGISTRATION
() EMPLOYMENT INFORMATION
() PROBATIONARY PERIOD

() T.B. TEST RESULTS

() COPY OF CURRENT CPR AND FIRST AID CERTIFICATE
() HEALTH SCREENING

() W-4
() JOB DESCRIPTION-SIGNED

() CODE OF CONDUCT AND ETHICS

() CONFIDENTIALITY

() DRUG TESTING POLICY

() VEHICLE & DRIVING REQUIREMENTS

() INSERVICE EDUCATION LOG

() PERFORMANCE REVIEW/EVALUATION
() COPIES OF CEU'S
() COPIES OF CERTIFICATE'S

1
Attach Copies Of Driver's License And Social Security Card:

Photo Copy of Driver's License:

Photo Copy of Social Security Card:

2
 EMPLOYEE CONFIRMATION

New Employee Name: ______________________________________________

Date of Employment: ______________________________________________

Current Position: ______________________________________________

Beginning Salary: ________________________

Rate Changes: ________________________

Potential Promotion: ________________________

________________________________ _____________________
EMPLOYEE SIGNATURE DATE

________________________________ _____________________
COMPANY OFFICIAL SIGNATURE DATE

3
 Application for Employment
PERSONAL INFORMATION
Last Name First Name Middle Initial Social Security Number

Present Address City State Zip Code

Date of Birth Home Phone Cell Phone

Are you legally entitled to work in the United States? Yes () No ()

(If you are hired you will have to present evidence of your right to work in the United States no later
than three days after the commencement of your employment)
Have you ever been convicted of a crime?
(Do not respond concerning the following: arrests or detentions that did not result in conviction; referrals to,
and participation in, any pretrial or post-trial diversion program; marijuana-related convictions more than two
years old; convictions for which the record has been judicially ordered sealed, expunged, or statutorily
eradicated; and misdemeanor convictions for which probation has been successfully completed or otherwise
discharged and the case has been judicially dismissed.)
Yes () No ()
If yes, what was (were) the offense(s)?

Date(s) and place(s) of conviction:

A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. Factors such as age at the time
of the offense, type of offense and relevance to the job for which you are applying, seriousness and nature of the
offense and rehabilitation will be taken into account.
Do you have any friends or relatives working for Recovery Institute Of America?
Yes () No ()
If yes, state name(s) and relationship.
___________________________________________________________________________________________
__
What Is The Reason Your Interested In Employment At Recovery Institute Of America?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________
Do You Hold A Up To Date Licensing Or Certification Or Are You Presently Registered Worker? Yes () No
()

4
 If So: Licensing , Certification Or Registration Agency
Name:__________________________________________

CREDENTIAL/CERTIFICATION/REGISTRATION
Number: ________________________________________ State: ____________ Expiration Date: ___________

Number: ________________________________________ State: ____________ Expiration Date: ___________

WORK INFORMATION
Position Desired Full Time Part Time Temporary
# Hours
Can you perform the essential functions of this job, with or without reasonable accommodation? Yes__ No__
(The Human Resources representative will provide a description of the essential functions of the position.)

Desired Pay Date available for work

Are you willing to work overtime? Yes____ No ___

How did you learn of this position?

EDUCATION AND TRAINING INFORMATION

School Name And Location Of School No. of Did you Degree or
years graduate? Diploma
High School Yes
No
College/ Yes
University No
College/ Yes
University No
Other

5
Do you have any other experience, training, qualifications or skills which you feel make you especially suited for
work at? If so, please describe:

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

6
EMPLOYMENT INFORMATION
(List Most Recent Job First)

Date Employer Phone

Start _____________
Left _____________

Address City State Zip

Salary Type of Business

Start $_____________
Left $____________

Supervisor(s) Job Title

Job Duties
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________
Reason for leaving:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______

Date Employer Phone

Start _____________
Left _____________

Address City State Zip

Salary Type of Business

Start $_____________
Left $____________

Supervisor(s) Job Title

Job Duties
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Reason for leaving:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

7
 EMPLOYMENT INFORMATION
(List Most Recent Job First)
Date Employer Phone
Start _____________
Left _____________

Address City State Zip

Salary Type of Business

Start $_____________
Left $_____________

Supervisor(s) Job Title

Job Duties
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

Reason for leaving:

______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

BUSINESS OR PROFESSIONAL REFERENCES

NAME PHONE YEARS OCCUPATION &
KNOWN RELATIONSHIP

PERSONAL OR FAMILY REFERENCES

NAME PHONE YEARS OCCUPATION &
KNOWN RELATIONSHIP

You may attach a sheet, if necessary, to provide further information regarding your work history.

8
 AN EQUAL OPPORTUNITY EMPLOYER

All employment decisions are made without regard to unlawful considerations of race, sex,
sexual orientation, gender identity, religion, national origin, age, disability, or any other legally
protected status. Reasonable accommodations are available to qualified disabled individuals,
upon request.

CERTIFICATION

Read carefully before signing application.

I certify that the information given by me in this employment application is true and
correct and contains no material omissions of any kind. I understand that any false statements
or material omissions of fact made by me in this employment application or the interview
process may disqualify me from employment or result in my termination. I authorize
Recovery Institute Of America, LLC to investigate my background and fitness for
employment, including, but not limited to, an investigation of all the information provided in
this employment application. I release Recovery Institute Of America, LLC, its employees
and agents from any and all liability for failing to hire me or terminating my employment due
to such false information or material omissions. I authorize the companies or persons named
above to give to Recovery Institute Of America, LLC any information regarding my
employment or educational background, together with any information they may have
regarding my qualifications for the job for which I am applying, whether or not it is in their
records. I hereby release said companies, schools or persons and their employees and agents
from any and all liability resulting from the disclosure of this information.

I understand and agree that if I am hired, my employment relationship with Recovery

Institute Of America, LLC. Is at-will, which means that it may be terminated at any time,
with or without cause or advance notice, by either me or Recovery Institute Of America, LLC.
In addition, if I am hired, Recovery Institute Of America, LLC will have the right to impose
discipline or alter my position at its discretion. I understand and agree that no representative
of the Company may enter into any agreement contrary to the foregoing unless it is done by
way of a specific, written agreement signed by the President and CEO or Program Director.

Signed: Date

FOR EMPLOYMENT OFFICE USE ONLY

9
 EMPLOYEE PROBATIONARY PERIOD

Due to the nature of our business, it is the policy of Recovery Institute Of America, LLC and our
affiliates, that every new employee is hired with the understanding that they are on a 6-month
probationary period.

During this initial 6-month period, Recovery Institute Of America, LLC or the new employee has the
right to terminate “at will”, without cause and without prior notification.

This policy is in place to protect the participants of Recovery Institute Of America, LLC Programs. In
addition, it provides adequate time for the company and the employee to evaluate each other.

It is the Recovery Institute Of America, LLC belief that in order to provide quality care for our
participants that the employee must agree and adapt to the program philosophy and approach.

The 6-month probationary period allows for adjustments to the company, as well as, allows the
company the ability to discharge employees who may be detrimental to the company and/or the
participants.

At the end of the 6-month probationary period all employees will be evaluated with a performance
review.

Understood, acknowledged and agreed:

___________________________________ ________________________________________
Recovery Institute Of America, LLC Official New Employee

___________________________________ ________________________________________
Print Name and Title Print Name

Date: ______________________________ Date: ___________________________________

10
Attach Copies Of Tuberculosis Test:

11
Attach Copies CPR & First Aid Certificate:

12
 STATE OF CALIFORNIA--HEALTH AND HUMAN SERVICES AGENCY Department of Health Care Services
Licensing and Certification Branch, MS 2600
PO Box 997413
Sacramento, CA 95899-7413

C-3 – FACILITY PERSONNEL HEALTH SCREENING REPORT

All personnel of an alcoholism or drug abuse recovery or treatment facility must demonstrate that their health condition allows them
to perform the type of work required. This health appraisal is to be completed by or under the direction of a licensed medical
professional not more than sixty (60) days prior to employment or within seven (7) days after employment.

Employee Name:

Job Title:

Number of Work Days a Week: Number of Work Hours per Day:

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION

I hereby authorize the release of medical information contained in this report.

Signature of Employee Date

Note to Physician: Personnel working in alcoholism or drug abuse recovery or treatment facilities shall be
in good general health, free from communicable disease, and occupationally capable of performing assigned
tasks. Please complete the following information on the above named person.

Evaluation of General Health:

Based on a review of the employee’s duty statement, are there any limitations on this individual's ability to
perform the work described and/or are there any health conditions that would create a hazard to participants or
other staff?

NO YES – If yes, please explain:

Signature of Licensed Medical Professional Title

Date

13
 DHCS 5077 (07/13)

COUNSELOR JOB DESCRIPTION & QUALIFICATIONS

The counselor must be familiar with all operational policies and procedures of Recovery Institute Of America, LLC.
He/she will oversee and direct the day to day counseling aspect of Recovery Institute Of America, LLC. The
counselor will be responsible to the clinical director.

Counselors help people to explore feelings about their lives so that they can reflect about what is happening to them
and consider alternative ways of doing things. Working in a confidential setting, counselors listen attentively to their
clients and offer them the time, empathy and respect they need to express their own feelings, and perhaps understand
themselves from a different perspective, thereby reducing their confusion and enabling them to make changes in their
life if they decide to do so.

Counselors do not give advice, but help clients to make their own choices within the framework of an agreed
counseling contract.

QUALIFICATIONS: The counselor must demonstrate knowledge of his/her abilities to develop, implement, and
direct treatment plans that insure problem solving skills and promotes growth for the clients that Recovery Institute
Of America, LLC serves. He/she will possess Certification or be registered in the field of addiction treatment as
evidenced by such certification issued by the state approved agency, i.e., CAADAC, CAADE, CSAC, etc.

If the individual is in recovery from an addiction, he/she must be actively involved in an ongoing recovery program
such as (AA, NA, CA, OA GA etc.). In addition to these requirements, an individual must possess a valid CPR
CERTIFICATE, FIRST AID CERTIFICATE, and current NEGATIVE TB TEST RESULTS.

Duties:
1. The counselor will conduct group, individual and educational sessions, as well as general supervision
with clients and their family members.
2. He/she will conduct assessments and develop treatment plans for all clients.
3. Establishing a relationship of trust and respect with clients.
4. Develop a counseling contract with the client as to what will be covered in sessions (including
confidentiality issues).
5. Encouraging clients to talk about issues they feel they cannot normally share with others.
6. Actively listening to client concerns and empathizing with their position.
7. Accepting without bias the issues raised by clients.
8. Helping clients towards a deeper understanding of their concerns.
9. Challenging any inconsistencies in what clients say or do.
10. Helping clients to make decisions and choices regarding possible ways forward;
11. Referring clients to other sources of help, as appropriate.
12. Attending supervision and training courses.
13. Liaising, as necessary, with other agencies and individuals to help effect change based on the issues
raised by clients.
14. Keeping records and charting in the appropriate manner.
15. The counselors will work as an hourly employee and will generally work 40 hour per week. The
counselor will agree to work any and all shifts as needed and as directed by the supervisor, and as
agreed upon by both parties.

Responsible to: Program Director and Clinical Director

I have read the above and agree to fulfill the job descriptions and qualifications to the best of my abilities.

14
__________________________________ _____________________________
Counselors Signature Date

RESIDENT MANAGER/ASSISTANT MANAGERS JOB DESCRIPTION

The Resident Manager shall be familiar with all operational policies and procedures. He/she will oversee and direct
the day-to-day facility operations and general supervision of clients.
QUALIFICATION: An individual must possess an understanding of the nature of the disease concept and its
respective recovery processes. He/she must also know the current federal, state, and local laws and guidelines for
social model treatment facilities. The individual will possess managerial and supervisory skills and abilities.
Demonstrate knowledge of his/her abilities to develop, implement, and direct treatment plans that insure problem-
solving skills and promotes growth for the clients that Recovery Institute Of America, LLC serves.
He/she will possess Certification or be registered in the field of addiction treatment as evidenced by such certification
issued by the state approved agency, i.e., CAADAC, CAADE, CSAC, etc. He/she will have at least one year of past
work or volunteer experience in the alcohol and drug abuse field.
If the individual is in recovery from an addiction, he/she must be actively involved in an ongoing recovery program
such as (AA, NA, CA, OA GA etc.). In addition to these requirements, an individual must possess a valid CPR
CERTIFICATE, FIRST AID CERTIFICATE, and current NEGATIVE TB TEST RESULTS.

Duties:
1. Resident managers are responsible to uphold and enforce the standards of the Recovery Institute Of
America program.
2. Resident managers are not doctors, counselors or therapist; they do not give advice, only
suggestions relying on personal experience, strength and hope. Any resident requiring more
directions will be referred to clinical staff for appropriate referrals.
3. Residential managers do not dispense medication. However, they will monitor all resident
medications.
4. Resident managers are responsible for participating in general daily schedule, which allows for
treatment team staffing, in-service meetings, house meetings, physical duties, curfew and personal
recovery program.
5. Resident managers are responsible for overall up- keep and safety maintenance of Recovery
Institute Of America physical property.
6. Resident managers are responsible for maintaining accurate documentation of residents on weekly
basis or when an accident presents itself.
7. Resident manager are responsible for supervising all assistant residential managers and with the
orientation of all new residents.
8. Resident managers are responsible for contacting administration immediately following any unusual
occurrences (i.e., police, ambulance, inspectors and/public officials, A.W.O.L., relapse, positive drug
test, ect). Resident managers are also responsible for referring any questions from public or
governmental agencies to Recovery Institute Of America administration.
9. Assistant resident manager while on duty will be responsible for delegating and rotating client
chores on a weekly basis.
10. Assistant resident managers will follow the same guild lines as given for a resident manager.

Responsible to: Program Director and Clinical Director

I have read the above and agree to fulfill the job descriptions and qualifications to the best of my abilities.

__________________________________ _____________________________
Managers/Assistant House Managers Signature Date

15
INTERN JOB DESCRIPTION AND QUALIFICATIONS
Recovery Institute Of America, LLC works with many schools to assist Interns further their education and
experience.

QUALIFICATION: Academic or work experience background in the field of chemical dependency treatment.
Enrollment in an academic course related to treatment for chemical dependency. Have the ability to communicate
effectively with patients in a treatment setting.
Background or experience in working as part of a team. Ability and willingness to accept supervision.

He/she will possess Certification or be registered in the field of addiction treatment as evidenced by such
certification issued by the state approved agency, i.e., CAADAC, CAADE, CSAC, etc.

If the individual is in recovery from an addiction, he/she must be actively involved in an ongoing recovery program
such as (AA, NA, CA, OA GA etc.). In addition to these requirements, an individual must possess a valid CPR
CERTIFICATE, FIRST AID CERTIFICATE, and current NEGATIVE TB TEST RESULTS.

Duties:
1. Work with assigned supervisor in group and education settings.
2. Work with assigned supervisor in developing skills related to California Association of Alcohol and
Drug Counselor 12 core functions or equivalent.
3. Document personal progress.
4. Attend all team functions as assigned.
5. Prepare one in-service for the team, and present same one week prior to completion of internship.
Supervision and evaluation:

1. Interns shall be supervised by the Clinical Supervisor or designee.

2. Interns shall be assessed on a quarterly basis or as required by their anticipated supervising board
or agency, with both a written summation of their performance, and a face-to-face interview with
their supervisor.
3. Interns are expected to adhere to all applicable policies of Recovery Institute Of America , LLC as
regards their position.
4. Interns may be disciplined or dismissed for the following reasons:
a. Violations of Recovery Institute Of America , LLC’s policies.
b. Failure to perform their duties as assigned.
c. Measurably poor performance, as assessed by their supervisor.
5. A verbal or written notice of performance deficiencies shall be given to the intern prior to other
disciplinary or dismissal procedures.
6. Interns are eligible for hire upon completion of their internship, based on performance and
company needs at the time, but internship alone does not constitute a job offer.
Responsible to: Clinical Director

I have read the above and agree to fulfill the job descriptions and qualifications to the best of my abilities.
16
__________________________________ _____________________________
Intern Signature Date

VOLUNTEER JOB DESCRIPTION AND QUALIFICATIONS

Recovery Institute Of America, LLC accepts experience and non-experienced volunteers. We welcome the
skills and positive energies of those so willing to volunteer there valuable time. Most volunteers come
from different colleges and or other avenues. Recovery Institute Of America, LLC does not recruit
volunteers. All Volunteers most understand and sign a client confidentiality form.

QUALIFICATION: Demonstrated skills in the area or field for which the individual is volunteering, for example,
clerical skills if volunteering for clerical duties. Have the ability to communicate effectively with patients in a
treatment setting. Background or experience in working with a team. Have the ability and willingness to accept
supervision.

He/she will possess Certification or be registered in the field of addiction treatment as evidenced by such
certification issued by the state approved agency, i.e., CAADAC, CAADE, CSAC, etc. If the individual is in recovery
from an addiction, he/she must be actively involved in an ongoing recovery program such as (AA, NA, CA, OA GA
etc.). In addition to these requirements, an individual must possess a valid CPR CERTIFICATE, FIRST AID
CERTIFICATE, and current NEGATIVE TB TEST RESULTS.

Duties:
1. As assigned in areas for which qualified. For example, assisting clinical staff, assisting management by
typing of letters using MS Word, Word Perfect, or assisting patients by making store runs.
2. Documenting personal progress.
3. Volunteers shall be supervised by the Clinical Director or designee.
4. Volunteers shall be assessed on a quarterly basis or as required by their anticipated supervising board
or agency, with both a written summation of their performance, and a face-to-face interview with their
supervisor.
5. Volunteers are expected to adhere to all applicable policies of Recovery Institute Of America , LLC as
regards their position.
6. Volunteers may be disciplined or dismissed for the following reasons:
a. Violations of Recovery Institute Of America , LLC’s policies.
b. Failure to perform their duties as assigned.
c. Measurably poor performance, as assessed by their supervisor.
7. A verbal or written notice of performance deficiencies shall be given to the intern prior to other
disciplinary or dismissal procedures.
8. Volunteers are eligible for hire upon completion of their volunteer tenure, based on performance and
company needs at the time, but the position of volunteer by itself does not constitute a job offer.

Responsible to: Counselors and Facility Manager

I have read the above and agree to fulfill the job descriptions and qualifications to the best of my abilities.

__________________________________ _____________________________

17
Volunteer Signature Date

CODE OF CONDUCT AND ETHICS

This Code of Conduct shall prohibit registrants and certified alcohol and other drug (AOD)
counselors and all other staff members from:

1. Securing a certification or registration by fraud, deceit, or misrepresentation on any application submitted to the
certifying organization whether engaged in by an applicant for certification or registration or in support of any
application for certification or registration.
2. Administering to himself or herself any controlled substance as defined in section 4021 of the Business and
Professions Code, or using any of the dangerous drugs or devices specified in section 4022 of the Business and
Professions Code or using any alcoholic beverage to the extent, or in a manner, as to be dangerous or injurious to the
person applying for a certification or holding a registration or certification, or to any other person, or to the public, or, to
the extent that the use impairs the ability of the person applying for or holding a registration or certification to conduct
with safety to the public the counseling authorized by the registration or certification.
3. Gross negligence or incompetence in the performance of alcohol and other drug counseling.
4. Violating, attempting to violate, or conspiring to violate any regulation adopted by ADP.
5. Misrepresentation as to the type or status of certification or registration held by the person, or otherwise
misrepresenting or permitting misrepresentation of his or her education, professional qualifications, or professional
affiliations to any person or entity, and failure to state proper certification or licensure initials and numbers on business
cards, brochures, websites, etc.
6. Impersonation of another by any counselor or registrant, or applicant for a certification or registration, or, in the case
of a counselor, allowing any other person to use his or her certification or registration.
7. Aiding or abetting any uncertified or unregistered person to engage in conduct for which certification or registration
is required.

8. Providing services beyond the scope of his/he registration or certification as an AOD counselor or his or her
professional license, if the individual is a licensed counselor as defined in Secton13015.
9. Intentionally or recklessly causing physical or emotional harm to any client.
10. The commission of any dishonest, corrupt, or fraudulent act substantially related to the qualifications, functions, or
duties of a counselor or registrant.

11. Engaging in sexual relations with a client or with a former client within two years from the termination date of
therapy with the client, soliciting sexual relations with a client, or committing an act of sexual abuse, or sexual
misconduct with a client, or committing an act punishable as a sexually related crime, if that act or solicitation is
substantially related to the qualifications, functions, or duties of an alcohol and other drug counselor.
12. Engaging in a social or business relationship with clients, program participants, patients, or residents or other
persons significant to them while they are in treatment and exploiting former clients, program participants, patients, or
residents.

13. Verbally, physically or sexually harassing, threatening, or abusing any participant, patient, resident, their family
members, other persons who are significant to them, or other staff members.
14. Failure to maintain confidentiality, except as otherwise required or permitted by law, including but not limited to
Code of Federal Regulations, Title 42, Part 2.
15. Advertising that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived;
makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is
relevant to the service being performed and can be substantiated with objective scientific evidence; makes a scientific
claim that cannot be substantiated by reliable, peer reviewed, published scientific studies.
16. Failure to keep records consistent with sound professional judgment, the standards of the profession, and the
nature of the services being rendered.
17. Willful denial of access to client records as otherwise provided by law.

Name:___________________________________________
(please print)

18
Signed:__________________________________________

Dated:__________________________________________

CONFIDENTIALITY ________________________________________________________
Policy: Federal and State confidentiality regulations authorize disclosure of information regarding the identity,
diagnosis, prognosis, or treatment of alcohol and drug program participants under specific guidelines. Recovery
Institute Of America, LLC, shall adhere to the regulations stipulated in the Code of Federal Regulations (Title 42,
Section 2.1 through 2.67-1), the State of California Welfare and Institutions Code (Sections 5326 through 5330) and
other provisions.
Any information, recorded or not, relating to a client of Recovery Institute Of America, LLC is to be afforded full
confidentiality as outlined in the above regulations. Exceptions to confidentiality are as follows:
1) If information about suspected child/dependent adult/elderly abuse or neglect is reported;
2) If clients threaten to harm themselves or others;
3) If the court orders that information be released;
4) If the client gives written permission to release information; or
5) Disclosure is made to medical personnel in a medical emergency or to qualified personnel for research,
audit or program evaluation.

Violation of the Federal and State Laws and Regulations by a program is a crime. Suspected violations may be
reported to the United States Attorney in the district where the violation occurs.
Federal regulations allow information sharing among programs with Qualified Service Agreements.

Procedures:

1. All staff and volunteers must sign below agreeing to an Oath of Confidentiality before they begin working at
Recovery Institute Of America, LLC
2. The Confidentiality Policy and the exceptions to confidentiality must be explained fully to clients at intake.
3. Telephone Answering: The telephones will be answered by program representatives properly trained to do
so. All receptionists shall be trained to not acknowledge whether or not an individual is a client of the
program. All inquiries regarding individuals that are, or have been, or might be a potential client of the
program should be treated with complete confidentiality; the caller shall be respectfully informed that this
information cannot be acknowledged either way and if they would like to speak to someone else, the call
will be transferred to another staff member. Calls should then be transferred as follows:

a) Re: current clients: calls regarding current clients should be transferred to the Clinical Director.
b) Re: unknown or past clients: calls should be directed to whichever staff seems the most
appropriate; intake, Clinical Director, Director of Operations, or Counselor.

4. Client file access: Client files will be maintained in a locked office and file cabinet as outlined in this
manual. Information maintained on computers is protected by password. Additionally, firewalls exist
limiting access to those on a “need to know” basis.
5. Release of Information: Information regarding a client may be shared to the extent that a release of
information, signed by the client, permits.
6. No employee shall use or disclose privileged or confidential information gained in the course of work or by
reason of his/her official position or activities.
7. Staff who fail to abide by Recovery Institute Of America, LLC’s Confidentiality Policy are subject to
termination of employment.

______________________________________ ______________________________________
Staff Name (Print) Staff Signature

______________________________

19
Date

DRUG TESTING POLICY AND AGREEMENT

I, __________________________________have read, understand and agree with the Drug

Testing Policies and Procedures of Recovery Institute Of America, LLC

Due to the nature of the business of drug and alcohol recovery, I understand the need for
Recovery Institute Of America, LLC to insist on my abstinence on the job.

Therefore, I willingly agree to pre-employment testing, as well as, random testing at the
discretion of administration as a preventative method of drug use, as well as, an intervention
process in an effort to protect the Recovery Institute Of America, LLC participants.

_______________________________________ __________
Employee Signature Date

______________________________________ __________
Staff Witness Date

20
VEHICLE & DRIVING REQUIRMENTS
Only authorized individuals may operate Recovery Institute Of America, LLC vehicles. All drivers
shall obey all traffic laws and speed limits and adhere to the policies and procedures described
herein.

1. The CEO or Program Director shall approve individuals as drivers provided they satisfy
the following criteria:

 Possess a current and valid California Driver’s License.

 Must have a current satisfactory DMV driving record.
 Must be insurable through the organization’s insurance agency. Our insurance carrier
conducts ongoing review of driving records.

2. Prior to departure the driver will inspect vehicle (fluids, windshields, mirrors, tires) and
complete a driver’s log sheet. Any problems regarding safety or operation of the vehicle
detected while driving shall be immediately reported to the CEO/Director of Operations
upon return to the facility.

3. Drivers and passengers must wear seat belts at all times while the vehicle is in operation.

4. Smoking, eating or drinking in any vehicle is prohibited.

5. Information packets are located in the glove compartment containing: 1) vehicle

registration, 2) our insurance information, 3) First Aid procedures, 4) Vehicle accident
statement and 5) instructions in case of emergency.

6. All vehicles shall contain a secured fire extinguisher, a secured First Aid kit, and
emergency roadside kit.

7. Drivers will assure there is no misuse or abuse of vehicles (e.g., do not rub tires on curbs
when parking, open and close doors with care, etc.)

8. The driver of a vehicle is financially responsible for any traffic violations or parking tickets,
and must report them immediately upon return to the facility to the CEO/Director of
Operations.

_______________________________________ __________
Employee Signature Date

______________________________________ __________
Staff Witness Date

21
 In-Service Training Log

(Must Document 12 Hours of Continuing Education Hours Per Year)

TRAINING DATE TOPIC HOURS TRAINER

22
 PERFORMANCE REVIEW/EVALUATION

STAFF NAME: TITLE:

Purpose: The purpose of conducting the Performance review and or evaluation is to:
Develop better communication between the employee and the supervisor; Improve the quality of work; Increase
productivity; and Promote employee development.

Performance Rating Categories: Consider the employee’s performance in each category and designate the level of
performance that most accurately describes his/her job performance.
O – Outstanding. Employee consistently exceeds E - Exceeds EXPECTATION. Results clearly exceed
position expectations with virtually no detected position requirements on a regular basis. Performance is of
preventable/controllable errors, requiring little or no high quality and is achieved on a consistent basis
supervision.

GENERAL INFO
M – Meets Expectation.
Competent & dependable
performance level. Meets the
performance standards and
objectives of the job without
constant follow-up /
direction.
I - Improvement Needed. N/A – Not applicable or too soon to rate.
Employee does not meet
constant follow-up and / or
supervision. Performance
objectives on a regular basis
and has difficulty following
through with tasks.

1. Quality – The extent to which an employee’s work is completed thoroughly and correctly following established
process & procedures. Required paperwork is thorough and neat.

O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

2. Job Knowledge - The extent to which an employee possesses and demonstrates an understating of the work
instructions, processes, equipment and materials required to perform the job. Employee possesses the practical and
technical knowledge required of the job.

O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

______________________________________________________________________________________

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 ______________________________________________________________________________________
______________________________________________________________________________________

3. Interpersonal Relationships / Cooperation / Commitment – The extent to which employee is willing and
demonstrates the ability to cooperate, work and communicate with coworkers, supervisors, subordinates and/or outside
contacts. Employee accepts and responds to change in a positive manner. Accepts job assignments and
additional duties willingly, takes responsibility for own performance and job assignments.

O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

4. Initiative / Creativity - The extent to which an employee seeks out new assignments, proposes improved
work methods, suggests ideas to eliminate waste, finds new and better ways of doing things.

O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

_______________________________________________________________________________________
_______________________________________________________________________________________

5. Adherence to Policy – The extent to which the employees follows company policies, procedures and work
conduct rules. Complies with and follows all safety rules and regulations, wears required safety equipment.

O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

_______________________________________________________________________________________
_______________________________________________________________________________________

6. Lead (if applicable)– The extent to which the employee demonstrates proper judgment and decision-
making skills when directing others. Directs work flow in assigned areas effectively to meet production / area
goals.

O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

_______________________________________________________________________________________
_______________________________________________________________________________________

Charting and Keeping Records - How well does employee keep Client records, CARF surveys, and filing of all
documentation.
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 O Outstanding O Exceed Expectations O Meets Expectations O Improvement Needed

Specific Examples / Comments:

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Overall Performance – Rate employee’s overall performance in comparison to position duties and responsibilities.

O Outstanding O Exceeds Expectations O Meets Expectations O Improvement Needed

II. Complete All of the Following Sections

Accomplishments or new abilities demonstrated since last review: ______________________________________

_____________________________________________________________________________________________
_____________________________________________________________________________________________

Specific areas of needed improvement: ___________________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________

Recommendations for professional development (seminars, training, schooling, ect...)

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Employee’s Comments: ________________________________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________

Supervisor Signature:

Supervisor Name:

Date:

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Employee Signature:

Date:

26