Recruitment Application Form

  • Employment Interest Form

  • Personal Information:

  • Format: (000) 000-0000.

  • Employment Desired:

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  • Do you have experience with providing therapy remotely?

  • Licensing/Credentialing Information:

  • Is this a secondary registration number?
  • Will you be bringing any clients with you if offered a position with Blue Oak?
  • Are you currently credentialed with any insurance companies?
  • Are there any prohibitions or barriers based on your past, current, or future employment that will prohibit you from serving any populations?

  • Clinical Skills and Interests

  • Your Interest in Blue Oak Counseling Services:

  • Resume or CV:

    Please upload your resume or CV below PDF format. PLEASE DO NOT UPLOAD IN WORD FORMAT.
  • Upload a File
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  • Thank you for your interest in Blue Oak Counseling Services. Unfortunately, Associates with a secondary registration number cannot work in a private practice setting. 

    You can still submit this form, however we encourage you to follow back up once you are licensed and we welcome you to re-apply at that time.

  • Send Application:

  • By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected.  

    We will review all information submitted and will follow up via email with a determination or next steps.

     

     

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