Associate Field Therapist Application
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Today's Date
*
-
Month
-
Day
Year
Date
Are you legally eligible to work in the USA?
*
Yes
No
Can you pass a Background Criminal Investigation (BCI) with the State of Utah?
*
Yes
No
Are you physically able to maintain visual and auditory awareness of youth for safety?
*
Yes
No
Are you able to hike through rough terrain with up to a 50lb backpack?
*
Yes
No
Do you have a minimum of a Master Level graduate degree? If yes, please indicate which one below.
*
Clinical Mental Health (CMHC)
Marriage and Family Therapy (MFT/LMFT)
Social Work (MSW/LCSW)
Certified Social Work (CSW)
No
Other
Other:
Do you currently hold an entry level license with the state of Utah to practice mental health counseling under the guidance of a fully licensed clinician OR are you able to obtain one prior to start date?
*
Yes
No
Prior to start date
Describe your outdoor skills/interests/experience in a personal or work related setting:
*
Please list all experience working with youth ages 13-17. Please list time periods, or day’s worth of experience and what was your interaction or role while working with them:
*
How were you referred to us?
*
Indeed
Cool Works
Backdoorjobs
Handshake
Referral
Online Search
Other (please specify)
Other:
When are you looking to move into a new position?
*
-
Month
-
Day
Year
Date
Please list at least three references and their contact information:
*
Resume:
*
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