First Name *

Last Name *

Phone *

Email *

How did you hear about this position? *

What are you looking for in a practice? *

Do you have a preferred start date? *

What is your availability and can you maintain a minimum caseload of 10 clients? *

What license do you currently hold? *

Do you have at least 2 years direct clinicial experience? *

Do you have 2 professional references that are available to speak with? (at least one reference needs to be in the mental health field) *

Do you have the ability to schedule regularly with clients and communicate with clients outside of session with appropriate boundaries if needed? *

Describe your clinical experience, the populations you’ve worked with and the populations you enjoy working with? *

List any trainings or certifications that you hold that would be beneficial for this positon? *

What therapeutic modalities do you use most often, and why? *

What is your experience with crisis management (passive and active SI/HI? Can you share examples? *

What approach would you use for a client who is not progressing in therapy? *

Are you comfortable using various forms of sofware and EHR systems? *

What are your short and long-term professional goals? *

Is there anything else that you would like to share?

Please attach your resume below *