Application Form

Mental Health Counselor

Part-time/Full-time
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Best way to contact you?*
Earliest Possible Start Date

MonthDayYear
Date
What license do you currently hold in Kentucky?*
If you are fully licensed in the State of Kentucky, when did you first become fully licensed (year):
How many years of experience do you have in private practice?*
At Mindful Mending, we are focused on working with trauma across the lifespan as well as specialize with children. Which of these areas are you interested in working in?*

Trauma WorkChildrenTeensAdults
We offer both in-person and telehealth environments. Which best meets your criteria for employment?*

In-person onlyHybrid (telehealth and in-person)
What position are you interested in working?*

part-time (available 25 hrs per week; 20 clinical hrs per week)full-time (available 30 hrs per week; 25 clinical hrs per week)
To remain accessible to our clients’ schedules, we require clinicians to offer availability after 4 PM and/or on weekends. (total of 6 hours each week)*

I can be available after 4pmI can be available on the weekendsBoth
We understand that you have many options in the area. Why are you interested in working with Mindful Mending?*
Upload Resume*

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Mental Health Counselor