SLC Clinical Team Member Application

The Speech & Language Center

Clinical Team Member Application
Are you ready to help children thrive?

We are excited to start this process with you!

Complete this application below, and we will be in touch soon.

Have a question?

Email info@slccares.com
Full Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
Email Address*
How did you hear about The Speech & Language Center?*

FriendWebsiteSocial MediaOther
What about The Speech & Language Center prompted you to apply?*
Which clinical position are you applying?

Physical TherapistSpeech Language PathologistOccupational TherapistBCBARBT
What are your goals for this position?*
How do you desire to grow in your first year at The Speech & Language Center?*
What expectations do you have for your leader, supervisor or mentor?*
Who is your ideal client?*
In a team environment, what role do you typically take on?*
We love games and toys! What is your favorite to use in therapy?*
If you had $100, how would you spend it on YOU (not therapy!)?*
We make learning fun! What is the nerdiest thing you do in your spare time outside of work? *
What is your preferred location(s)?*

Loudoun CountyHarrisonburg
What is your preferred setting? Check all that apply. *

Schools (Public, Private, Charter)ClinicOther
What is your preferred work schedule?*

Full-TimePart-timePRN
Are you available to work after school hours?*

YesNo

References*

	Full Name	Email Address	Phone Number	Relationship	Location
Reference
Reference

The Speech & Language Center