STLDBT Therapist Application Form

St. Louis DBT Therapist Application

Please complete the form below, submit your cover letter and resume, and list two professional references. References will not be contacted until after interview process.
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
How were you referred to us?*

Current EmployeeNewspaper AdFacebookLinked-InInstagramOther
Upload Cover Letter

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Upload Resume

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Job Skills & Training
Check all that Apply

I am a Licensed Mental Health ProfessionalI am a pre-licenced social worker (LMSW)I have completed a basic 2-day DBT training or equivalentI have read Marsha Linehan’s DBT manualsI have read Kelly Koerner’s “Doing DBT” or another DBT manualI have completed an intensive DBT trainingI have attained DBT certification through DBT-LBCI have had 3 or more DBT individual clientsI have facilitated a DBT skills groupI have been on a DBT consult teamI am currently on a DBT consult teamI am not interested in DBT, but do provide another evidence-based therapy (list below)
Other Training or Certifications:
I am interested in:

Part Time (5-35 hrs per week)Full Time (35+ hrs/ week)Either PT or FT
I am interested in:

Contract position (paid a percentage of billing collected and no benefits)Salaried Position (FT, w/ benefits)Hourly Position (PT, no benefits)
References

Please list two (2) references that are familiar with your work life. References will NOT be contacted until after the interview process. By listing a reference here, you are agreeing to allow STLDBT to send this reference a survey about your work performance and suitablity for this position.
Reference 1
Reference 1 Name:*

First NameLast Name
Reference 1 Phone Number*

Area CodePhone Number
Reference 1 Email
example@example.com
Years Known:*
Reference 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Reference 2 Name:*

First NameLast Name
Reference 2 Email
example@example.com
Reference 2 Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty:

St. Louis DBT Therapist Application