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

What is your license status?*

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?*

Are you available to work at least 25 hours per week and have 20 available client openings?*

YesNo

Are you available to work evenings and/or weekends?*

YesNo

Do you have experience working with couples and families?*

YesNo

Are you willing to provide therapy services to couples and families?*

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?*

Do you have previous private practice experience?*

YesNo

California Counseling Collaborative brings on clinicians who can commit to working solely at CCC. We value work-life balance for our team who can be more invested in our culture and mission. Will you be working in your own private practice or at another group practice or agency if employed at CCC?*

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