Employment Interest Form!!

Employment Interest Form!!
Welcome!

We're so excited that you're interested in joining Your Next Chapter Counseling! We are a passionate and affirming team dedicated to providing compassionate, high-quality mental health care to our community. This form will help us get to know you a little better and learn more about your experience, interests, and what you're looking for in a practice. Thank you for taking the time to share with us—we look forward to connecting with you soon!
Basic info
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What are your pronouns?
What is the best way to contact you?*

TextPhone callEmail
Where do you live currently? *
City, State
Do you currently receive services at Your Next Chapter Counseling or personally know any current YNC clients?*

YesNo
Do you know any YNC therapists personally? If yes, who?
Do you identify as a person with unique lived experiences that could help meet the needs of an underserved population? (OPTIONAL)

YesNo
If yes, please explain:
Have you previously applied for a position at Your Next Chapter Counseling?*

YesNo
How did you hear about us and what made you want to apply for this position? *
Professional info
Licensure Type & State (LCSW/A, LCMHC/A, LMFT, etc)*
License Number
NPI number (if applicable)
Years of experience in Mental Health
Do you have a CAQH?

YesNoI have no idea
Work Preferences and Availability
Are you looking for full-time or part-time work?*

Full-timePart-timeOpen to either
Which location are you interested in working in?*

HendersonvilleAshevilleWaynesville (coming soon!)Telehealth
What days/times are you available to see clients?
Are you comfortable providing in-person, telehealth, or both?*

In-person onlyTelehealth onlyBothNo preference
Clinical Focus and Experience
What populations are you wanting to work with?*

Children 3+Children 5+Children 12+TeensAdultsCouplesFamiliesLGBTQIA+BIPOCNeurodivergentOther
What are your areas of specialty?
(Trauma, Anxiety, Depression, Grief, etc.)
What treatment modalities do you use?
(CBT, DBT, EMDR, ACT, etc.)
Supervision and Licensure Support
Are you currently receiving clinical supervision?*

YesNo
If so, who is your current supervisor?
(Name and credentials)
If you are offered a position at YNC, would you be interested in utilizing in-house supervision?

YesNoUndecided
Training & Certifications
Have you completed any formal HIPAA training or certification?*

YesNo
If yes, please list the training/certification and the year completed
Have you completed any trainings focused on working with trans, nonbinary, and LGBTQIA+ individuals?*

YesNo
If yes, please list the training(s) and year completed
Have you completed any anti-racism, cultural competency, or social justice related trainings?*

YesNo
If yes, please list the training(s) and year completed
Are there any other trainings, certifications, or continuing education courses you’ve completed that align with Your Next Chapter Counseling’s mission and values?
Administrative & Logistics
Are you legally authorized to work in the U.S.*

YesNo
How soon would you be available to start?*
Are you currently working as a Mental Health provider?*

YesNo
If yes, where are you currently working?
Interview Availability
What days/times are you available for an interview? *
Do you require any accommodations for an interview?*
(virtual, elevator, etc)
Practice Values and Commitment to Affirming Care

At Your Next Chapter Counseling, we support ALL members of our community. We strive to provide a welcoming and accepting space for people of all races, ethnicities, neurodivergencies, different abilities, identities, and spiritual beliefs. We are committed to advocacy in our community and using our voices to lift up marginalized populations.We believe that every person is deserving of love, acceptance, and authenticity. We recognize that humans are hardwired for healing, and we strive to provide a therapeutic, supportive environment for all of our clients on their healing journey.
💙 Our team is committed to anti-racist, affirming, and inclusive practices. If you join our team, you will be expected to uphold these values in your work with clients and colleagues. Do you agree to uphold and practice these values in your clinical work and interactions with colleagues?*

Yes, I wholeheartedly align with these valuesI would like to discuss further before committingNo, I do not align with these values
Is there anything additional you think we should know about you?
Please upload your resume *

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If applicable, please upload your cover letter

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Upload any relevant licensure documents (optional):

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Employment Interest Form!!

Basic info

Professional info

Work Preferences and Availability

Clinical Focus and Experience

Supervision and Licensure Support

Training & Certifications

Administrative & Logistics

Interview Availability

Practice Values and Commitment to Affirming Care