Freedom2Care Federal Service Survey
Questions marked with an asterisk (*) are mandatory.

Thank you for responding to this survey, which isponsored by Freedom2Care (www.Freedom2Care.org), a coalition of 50 organizations that is sponsored by the Christian Medical Association (www.joincmda.org).

 

 This survey is designed to insure a match between your interests and values and opportunities within the federal government for:

  • employment;
  • commission service;
  • expert testimony.

Since some of these opportunities involve values-based decision making and policy setting, some questions address religious, philosophical and political values. You are free to answer whichever questions you choose; however, candidates for certain opportunities will be selected based on responses to specific questions, so answering each question is to your advantage.

When you submit this survey, you will have an opportunity to further strengthen your opportunities for federal service by uploading your CV and other professional information on LinkedIn.

Thank you for your participation!
Personal information
1
Personal contact information
First name
Middle name
Last name
Suffix (e.g., Jr.)
Degree (e.g., MD)
Home address 1
Home address 2
City/Town
State/Province
Zip/Postal code
Home phone
Personal email
Any other personal contact info.
2
Gender
Male
Female
3

Ethnicity / Race – check all applicable:

American Indian or Alaska NativeAsian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Other, please specify
4
Religion
Christian
Jewish
Muslim
Hindu
Buddhist
Other, please specify
5

If you checked "Christian" above, please indicate your level of agreement with the following statements.

 I believe:

In the divine inspiration and final authority of the Bible as the Word of God;

In the eternal God revealed in Holy Scripture as Father, Son and Holy Spirit;

In the unique Deity of Jesus Christ, God’s only Son, whose death and resurrection provide by grace through faith the only means of my salvation;

In the transforming presence and power of the Holy Spirit.

I agree with all of the above statements.
I agree with some of the above statements.
I do not agree with the above statements.
I am not sure of my agreement with the above statements.
Professional information F2CProfessionals
6

Specialties (note if board certified)

Specialty 1
Specialty 2
Specialty 3
7
Work contact information
Your title
Place of employment
Dept./Division/Other
Work address 1
Work address 2
City/Town
State/Province
Zip/Postal Code
Work phone
Work email
Other work contact info.
8
Check the one response below that best indicates the highest number of personnel you have managed and provide brief details.
0 staff
1 - 10 staff
11 - 100 staff
Over 100 staff
Details:
Expertise and interests F2CProfessionals2
9

Public policy issues

Check all issues below in which you have significant knowledge, expertise and/or experience:

abortifacient drugs
abortion
abstinence education
adoption
assisted suicide / euthanasia
bioethics
bioterrorism preparedness
conscience rights
elderly care / abuse
fetal pain
healthcare - public programs (e.g., Medicare, Medicaid)
healthcare economics
healthcare policy
healthcare privacy
homeland security
homosexuality
human cloning
human trafficking
international health
marriage
medical education
medical ethics
minority health
nanotechnology
organ transplantation
physician shortage
poverty and health
pregnancy centers
prostitution
religious freedom
reproductive health
reproductive technology
research ethics
rural health
stem cell research
ultrasound
vaccine policy
Other, please specify
10

Healthcare issues

Check all issues below in which you have significant knowledge, expertise and/or experience:

adolescent health
aging
alternative medicine
birth control
embryology
end-of-life care
faith-based health care
fetology
fetal surgery
genetics
healthcare administration
healthcare research
healthcare safety
international health
malpractice
maternal health
mental health
pediatric health
public health
sexual issues
spirituality and health
Other, please specify
11

Disease-specific issues

Check all diseases and conditions below in which you have significant knowledge, expertise and/or experience:

Alzheimer's
diabetes
breast cancer
fistula
heart disease
HIV-AIDS
influenza / pneumonia
malaria
obesity
substance abuse
tropical diseases
tuberculosis
Other, please specify
12
Check all opportunities you would consider.
employment in a government position
service on a government board or commission
providing counsel on background (privately) to government officials
public testimony before legislative committees or government agencies
Comments:
13

HHS Committees (optional)

The U.S. Dept. of Health and Human Services offers opportunities for qualified individuals to serve on any of several hundred federal commissions. If you already know of commissions in which you are especially interested in, please indicate those below. Otherwise, skip this step (you will have opportunity to learn more about commissions after completing the survey) and continue to the next question.

Commission 1
Commission 2
Commission 3
Politics F2CCapitol
14
List all the affiliations below that apply to you:
Democrat
Republican
Independent
Other:
15
List all the descriptors below that describe your political views:
Conservative / traditional
Moderate
Liberal / progressive
Pro-choice
Pro-life
Comments
16
Check all that apply.
Voted in most recent election
Contributed to a political campaign in most recent election
Served on a political campaign in most recent election
Served in a political office
List details for checked items:
17

Political / Public Policy organizations

List below any political or public policy organizations that you belong to, support and/or participate in:

Organization 1
Organization 2
Organization 3
Organization 4
Organization 5
Media  FoxNewsNPR WP
18

Check all that apply:

No media experience
Participated in media training
Some television interview experience
Significant television interview experience
Some radio interview experience
Significant radio interview experience
Some print media interview experience
Signifiant print media interview experience
Other, please specify
19
If not already included in your CV (which you will have an opportunity to upload), please provide titles and/or links to published articles you have written–including in journals, newspapers, magazines, blogs and other online sites.
Almost done... F2Cprofessionals3
20
Some positions in federal service require extensive background checks, and high-profile positions sometimes spur background research by non-government groups. Please anticipate below any sensitive or controversial professional or personal issues that might arise in a thorough background check, along with any explanations you wish to offer.
21
Add here any additional comments you wish to make:
22
* I hereby affirm that all of my responses to this survey are accurate and true to the best of my knowledge. I understand that any information I submit on this survey and on the Freedom2Care LinkedIn group site may be shared with government officials and staff and others for consideration for opportunities including, but not limited to, employment, counsel, commission service and public testimony.
I agree to these terms
I do not agree to these terms

Next step: LinkedIn

After you hit the Submit button below, you will be redirected to the Freedom2Care group site on the premier professional network, LinkedIn (www.linkedin.com). There is no fee for this service.

The Freedom2Care group on LinkedIn will provide you with:

  • notices of opportunities for federal employment, commission service and expert counsel and testimony;
  • tips for seeking positions;
  • discussion topics with colleagues, and more.
Click the Submit button below and then follow the prompt to:
  1. sign up or sign into LinkedIn;
  2. (optional) upload or update your CV and professional information; and 
  3. join the Freedom2Care group on LinkedIn to keep updated on your opportunities.