SP Interest Questionnaire

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* 1. How did you hear about our SP program?

I know an existing SP.

On social media

I know a physician examiner or an assessor.

Other

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* 2. What is your first name?

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* 3. What is your last name?

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* 4. What is your legal name if different than above for payment and tax purposes?

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* 5. Please indicate languages you speak fluently and would be comfortable interacting and portraying your role in:

English Only

French Only

Both English and French

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* 6. Please indicate other languages you speak fluently (if any):

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* 7. What is your email address?

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* 8. What is the best number we can reach you at?

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* 9. What is your main reason for wanting to join the SP program?

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* 10. Are you interested in working as exam support staff on exam days or other events involving the SP program?

Yes

Maybe

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* 11. As an SP, are you comfortable having a non-invasive physical exam performed on you (e.g. listen to your lungs, listen to your heart, abdominal exam, knee exam, shoulder exam)? (Please note, we also have roles that are only history takings)

Yes

Maybe. I'd like to know more about what is involved.

Other (please specify)

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* 12. Would you be interested in learning more about our ongoing sensitive exam training (e.g. breast exam, speculum/bimanual exam)?

Yes

Maybe - I would like to know more about what is involved.

Other (please specify)

Personal Characteristics Questions
The University of Ottawa SP program aims to create a group of SPs that reflects the diversity of our community, and as such, the information collected below will be maintained in the SP database and used to select SPs for work offers, with the ultimate goal of helping our health professionals and students learn about treating a diverse population.

In addition, certain teaching and assessment projects may require SPs who possess certain personal characteristics (e.g., physical examinations). The data collected below will be used in those circumstances to identify suitable SPs on the roster for employment opportunities. Although completion of the below information is voluntary, the failure to provide responses may limit the work opportunities that are made available to you (e.g., If you do not disclose a gender identity, you will not be contacted for work opportunities that require a particular gender identity). Also note that all personal information is housed on a secure University of Ottawa server and the SP administrators are the only people who can access the data. If, within 12 months of completion of this survey you are not offered work in the program, your information will be deleted from the wait-list - this can also be done upon request at any time.

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* 13. Please indicate your age

under 15

15-17

18-24

25-34

35-44

45-54

55-64

65-74

74+

Gender identity refers to each person's internal and individual experience of gender. It is their sense of being a woman, man, both, neither, or anywhere along or outside of the gender spectrum.

Gender expression refers to how a person expresses their gender through behaviour and outward appearance such as dress, hair, make-up, body language, and voice. A person's name and pronoun are also common ways of expressing gender identity.

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* 14. How do you describe your gender/expression? Select all that apply.

Two Spirit

Gender non-conforming

Non-binary

Cis woman(your gender identity is the same as the gender you were assigned when you were born )

Cis man (your gender identity is the same as the gender you were assigned when you were born)

Two spirit

Queer

Trans woman

Trans man

Not listed (please add below_)

Prefer not to answer

Other (please specify)

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* 15. What pronouns do you use? This helps us understand the best way to address you. Please select all that apply.

They/them

She/her

He/him

Prefer not to answer

Not listed (please specify)

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* 16. Do you identify as First Nations, Inuit or Métis?

Yes

Prefer not to answer

Not listed (please specify)

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* 17. Do you identify as part of a racial/ethnic group?

Yes

Prefer not to answer

Not listed (please specify)

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* 18. Do you identify as a person with a disability?

Yes

Prefer no to answer.

Not listed (please specify)

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* 19. Are you a current or former University of Ottawa student who studied at our faculty of medicine or is enrolled in our new pharmacy program?

Yes

Thank you for completing your interest form - don't forget to click the SUBMIT button at the bottom of this page.

NEXT STEPS

1.      Once we’ve received your interest survey, you will be placed on our wait-list. We typically, though not exclusively, hire new SPs into the program based on need. When selected, you will be contacted by a member of our team to schedule a virtual meeting or telephone interview.

2.      The virtual interview will last roughly 30 minutes and will focus on your interest in the program. The discussion is an opportunity for us to get to know one another! You will also have the opportunity to ask questions.

3.      After the interview, you’ll receive an email from us informing if you’re being offered a place on the SP team.