Annette Fowler

St. Christina's Psychiatric Rehabilitation Center & St. Christina's Medical Center.

Please use blue or black ink when filling out this application for employment. Please answer all questions to the best of your ability. For further information or guidance, please contact a member of St. Christina staff at the number provided in our guide brochure.

Full Name: FOWLER, ANNETTE

Age: 47
DOB: 03/01/1964
Gender: Female
Address: The Hadley Institute for Troubled Youth 2723 Cruickshank Rd
City:Phoenicia
State: New York
Ethnicity: Caucasian
Height: 5’9”
Weight: 145lbs Approx.
Eye Color: Blue Grey
Hair Color: Red
Distinguishing Marks: I have a birth mark on my left hip and minor scars from my childhood.


Medical History:

Be advised that answers to this section will not have bearing on your eligibility for employment at the St. Christina Facilities. The information you provide will not be diverged to third parties.

Please list any and all allergies and age of onset below:
I have a mild allergy to cats and have since a young age. I’m unaware of when it was properly discovered but as a child I was unable to be around my grandmother’s cat without my eyes itching and watering.

Are you aware of any ongoing medical issues?:
I am unaware of any issues.

If yes, list age of diagnoses by medical professionals, or age of onset below:
N/A

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:
N/A

Do you smoke tobacco, consume alcohol, or use street drugs? If yes, please list number of packs per day, number of drinks per day and/or names of consumed drugs below:
I do enjoy a glass of wine with dinner from time to time but no more than two in a sitting. I consider myself a social drinker but do not make a habit of getting fully intoxicated.



Employment Interview:

To which location are you applying for employment? Please choose: St. Christina Psychiatric Rehabilitation Center/St. Christina Medical Center:
St. Christina Psychiatric Rehabilitation Center.

For which position(s) are you applying within the St. Christina Facilities? Please also list the facility to which you are applying:
I am applying for the position of psychiatrist on the adult ward.

Why do you feel that you would be the best choice for this position?:
While I worked with children while at Hadley my focus has been adults and I do wish to return to what I was specifically trained to do. I have worked in an institution setting for a vast majority of my career and feel that I will benefit the patients in that I know how to handle myself in such an environment.

Do you possess necessary qualifications for the position(s) for which you are applying? If yes, please list official qualifications below:
I have some experience in hypnotherapy and am continuing my study. While this is not an official qualification I felt it should be noted since it is something I plan to continue study on and hope to qualify for in the future.

Have you ever worked in a psychiatric or medical facility before? If yes, please provide facility name and dates of employment below:
Yes, I worked in Hartford Hospital Institute of Living and have since 1981. I left early this year to seek employment at the Hadley Institute for Troubled Youth.

Are you aware of any mental, physical or emotional impediments whatsoever that you feel may interfere with your ability to perform in the position(s) for which you are applying? These may include, but are not limited to substance addictions, medical issues, moral complications or difficulties working under pressure or strict guidance. If yes, please explain below:
I am unaware of any such complications.



Qualification History:

What is the highest level of education you have completed? Please list year of graduation and all courses completed below:
I have completed my doctorate in the medical field, specializing in psychiatric care. I completed my residency in 1981.

Please provide the name(s) of schools from which you have graduated below:
I attended the University of Connecticut for my undergraduate but went on to Yale University Medical School once I graduated. I did my residency at Hartford Hospital where I continued to work.

Do you possess any other skills that you feel may benefit your ability to perform in the position(s) for which you are applying? Examples include extra languages, history of customer service and work in the care industries, etc. If yes, please list skills below:
I have studied hypnotherapy techniques extensively and feel that this allowed me another way to aid my patients.

Please list all previous employment below, including locations and approximate dates of employment:
Hartford Hospital Institute of Living: 1981 – 2011
Hadley Institute for Troubled Youth: 2011

How do you feel your previous employment will benefit your ability to perform in the position(s) for which you are applying?:
I have worked in an institution setting for my entire career and feel that this better prepares me for the complications that can come with that. I’m aware that those confined to an institution will behave differently than those who visit an office week to week and I honestly prefer this type of setting. I feel that I can work better with my patients if I can seem then as frequently as needed. Because of my preference I’m more comfortable on the wards and able to perform under high stress situations.



Legal History:

Be advised that answers to this section will not have bearing on your eligibility for employment at the St. Christina Facilities. The information you provide will not be diverged to third parties.

Do/did you ever abuse controlled substances, including but not limited to prescription medications, street drugs or alcohol? If yes, please explain below:
I have never abused any controlled substances.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:
N/A

If you answered yes to the above, please list sentences connected to these convictions below:
N/A

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:
N/A



Personal Interview:

Describe yourself to the best of your ability in only five words:
Dedicated, profession, friendly, open minded.

Describe how you would handle a situation in which a patient may become violent towards themselves or others:
The first thing is to get the situation under control. Rushing in with not plan will only result in you getting hurt and possibly the patient as well. If they cannot be talked down they will need to be physically restrained by either myself or another member of staff more capable. The student would be removed from the population until they’ve calmed down and only then will I sit with them to figure out what happened. Medication changed may be necessary depending on the cause of the sudden outburst. Only if the patient cannot be physically restrained will chemical restraints be used.

If your immediate supervisor instructed you to complete a task to which you felt morally opposed, how would you handle the situation?:
I would take the time to sit with my immediate supervisor and explain my standing on the task that which was dictated to me. I’d ask that they respect my wish to not complete the task and that they hand it off to someone who is capable of what they ask. If an understanding can be reached then there will be no problems. If not, further discussion will be needed.

If you discovered a fellow employee breaking facility rules and endangering patients or staff, how would you handle the situation?:
I would report them to my superiors immediately and not attempt to handle the situation myself.

If hired, would you agree to sign a binding non-disclosure agreement, knowing fully that you would hence forth be unable to discuss any procedures, methods, patient information or staff information with anyone outside of the St. Christina Facilities and their staff?:
Yes, I would.

If hired, would you agree to follow any and all instructions given to you by facility supervisory staff and administrative staff without question, and knowing that you would be unable to discuss decisions with outside parties?:
Yes, I would.


Green Ridge Residential Registration:

Please list your chosen address within Green Ridge:
23 Holden Street

Please list any dependants under the age of thirteen, who reside with you:
N/A

Please list your marital status. Single/Married/Divorced/Widowed:
Single

If married, please provide the name of your spouse if he/she resides with you:
N/A



Employee Signature:

By applying for and accepting employment within any of our facilities, you hereby agree to abide by all rules and terms of service outlined in employee handbooks, rules and codes of conduct. You hereby agree to undergo a background check and/or drug test should GR Biotech feel it pertinent prior to accepting your application for employment. You hereby agree to undergo any further, random drug testing should it be necessary. You hereby agree to communicate and work in accordance with fellow facility staff in regards to the recommendations, demands, or outlines for treatment of the patients in the facility, and to comply with your immediate supervisor should she/he suggest differently. You hereby agree to waive your right to hold GR Biotech and its Subsidiaries responsible for any personal harm or distress incurred during or after employment. You hereby waive your right to communicate with any non-St. Christina Facility staff regarding any facility methods or procedures or patient information or treatments. GR Biotech and its Subsidiaries reserve the right to add or amend these terms of service at any time.

By opting to relocate to Green Ridge Island and the town of Green Ridge, you hereby agree to abide by all Green Ridge Island laws and the instructions of Green Ridge Security, Green Ridge Town Officials, and St. Christina Facility administrators. You hereby waive rights granted to you by the state of Oregon or any other state belonging to the United States of America or to any other country or county. You acknowledge that Green Ridge Island, the town of Green Ridge and the St. Christina facilities are not subject to any state laws. You acknowledge that any personal property transported to Green Ridge Island becomes the responsibility of GR Biotech and its subsidiaries. You hereby waive your right to register to vote in any states within the continental United States, within the states of Alaska and Hawaii, and within any US territories. You waive your right to representation by any political parties or persons within the aforementioned US locations or other countries. You acknowledge that you are legally bound not to disclose information regarding Green Ridge laws, protocols or procedures of any kind with persons not residing on Green Ridge Island. You acknowledge that visitors to Green Ridge Island become the sole responsibility of the undersigned, and are subject to the same laws, protocols and procedures as Green Ridge island residents during their stay. You acknowledge that visitors to Green Ridge Island are subject to surveillance by Green Ridge officials and employees, and may be removed from the island without notice. You acknowledge that any minors under the age of thirteen (13) that are claimed as dependants remain the sole responsibility of the undersigned, and are subject to the same laws, protocols and procedures as all Green Ridge Island residents. GR Biotech and its Subsidiaries reserve the right to add to or amend these terms of service at any time.

Please sign and date below:

Dr. Annette Fowler 05/16/2011

Thankyou for taking interesting in joining our dedicated team of St. Christina's staff. Below, you'll find your employment and residential details. Whether you applied to our Medical Center or our Psychiatric Rehabilitation Center, we ask that you take this time to familiarise yourself with pertinent handbooks, rules and regulations, and we welcome you to green Ridge and to the St. Christina's team.

Job Title: Adult Psychiatrist
Location: St. Christina Psychiatric Rehabilitation Center
Residential Address: 23 Holden Street


Final Application Approval Steps for Players:


Before you can begin play on STC, you must complete these final steps:

• Sign up your playby on the faceclaim.
  
• Sign up for the who plays who list.
  
• Sign up for your assigned membergroup (shown above) HERE (Pay close attention to pick the correct usergroup listed on this approval stamp! Characters that are not signed up for their correct membergroups after approval will be subject to deletion during the next activity check.)
  
• Familiarise Yourself with your Staff & Resident Handbooks, located in the St. Christina's Rosters and Information, and Green Ridge Rosters & Information forums, on the main board.

Code:

[center][font=garamond][size=22][color=#555555][b] -File Note- [/b][/color][/size][/font]

_____________________________________________________________[/center]

[b]Employee Name:[/b] Fowler, Annette
[b]Job Title:[/b] Adult Psychiatrist
[b]Location:[/b] St. Christina Psychiatric Rehabilitation Center
[b]Residential Address:[/b] 23 Holden Street

[center]_____________________________________________________________[/center]

[b]Note Subject:[/b] (Behavioural Report, Progress Report, Procedure Report, Disciplinary Report, etc.)

[b]Note Contents:[/b] (Explain behaviour observations, procedures, disciplinary actions, medical reports, etc. here)

[b]Note Author:[/b] (Your character name here.)

[b]Other:[/b] (Optional extra notes here.)