GCI Clinical Application Form

GCI Employment Application

Please thoroughly complete the application form below for us to get to know you better. We want to assess your potential and fit to work with us. Thank you for your interest.
NOTE: Avoid filling the application on mobile devices.
Name:*

First NameLast Name
Birth Date

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Resume:
Job Skills & Training
We're excited to get to know you better. If you're reading this message, it is because you've been identified as a potential fit for the organization. Please answer the following questions thoughtfully and thoroughly. Many applicants have asked to be considered for this position.
1. What continuing education training or certifications have you completed (beyond formal education) related to the position? (Please be detailed, including when, and how you've applied what you've learned. EMDR, sex therapy, DBT, ACT, EFT are desired.)*
2a. Please tell us how you handle difficult couples:*
2b. Please tell us how your own level of assertion helps you do couples therapy:*
3. At this point in your professional career, what is your ability to suppress previous training and perceptions about what works in couples therapy?*
4. Please describe your interest in, and experience working with the LGBT+ community.*
5. Please tell us how you deal with couples that are criticizing one another in the session.*
6. At this point in your professional career, how do you feel about video or audio recording your sessions and regular supervision?*
7. What is your highest degree awarded, type of degree and major, and year? (Ex. MA, Counseling Psychology, 2002)*
References

Please list two (2) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
How do you know this person?*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How do you know this person?*
Given the virtual nature of this work, your comfort with technology is completely critical. We'd like to ask some questions regarding your experience with the following applications.
Are you comfortable with using Trello?*

YesNo
Are you comfortable with using Slack?*

YesNo
Are you comfortable with using Zoom?*

YesNo
Are you willing to purchase your own Zoom professional account (about $150/yr)? This allows you to see clients longer than 40 min at time.*

YesNo
Are you comfortable with using Google Docs?*

YesNo
Are you familiar with using Facebook Groups?*

YesNo
Are you familiar with using an online scheduler? (N/Y) If so which?*
Are you willing to purchase your own coaching malpractice insurance (about $250/yr)?*

YesNo
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. *

YesNo
Signature*

Clear
Should be Empty:

GCI Employment Application