Application

California Counseling Collaborative Employment Questionnaire
Thank you for taking the time to apply for a therapist position at our practice. To streamline the process and be sure we are an appropriate match, please fill out this questionnaire.

Name:*

First NameLast Name

Phone Number:*

Area CodePhone Number

Email*

example@example.com

LicensedProvisionally Licensed

If provisionally licensed, when do you anticipate full licensure?*

Are you paneled with any insurance? If so, what insurance?*

Please tell us about your specialty/niche(s). List any certifications, previous experience, or any other information that informs us about your ability to work with that population(s).*

Who is your ideal client?*

YesNo

What is your ideal schedule?*

What would you say is your preferred clinical orientation?*

Why do you want to work in a group practice? Why California Counseling Collaborative?*

What are your long term goals (1-3 years out)? Personally and/or professionally.*

What can you bring to California Counseling Collaborative that sets you apart from other candidates?*

Why do you want to work in a group practice? Why California Counseling Collaborative?*

Tell us about your personality. How would colleagues describe you?*

YesNo

Thank you for your interest in our practice and taking the time to apply. Applicants who complete the requirements and match our needs will be contacted for an in-person or online video interview. If you haven't already, please email your resume and cover letter to californiacounseling@outlook.com