Counselor Job Application

Counselor Job Application

Join the mission of Rooted Counseling: providing gospel-centered, clinically excellent, and theologically faithful care for those navigating relational and sexual brokenness.
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
How did you hear about us*
Please Specify
Highest Degree Earned*
University/Institution Name*
License Type:*

LPCLPC AssociateLMFTLCSWGraduate Student/InternOther
License Number(s) & Issuing State(s)*
Date of Licensure*
Are you currently under supervision?*

YesNo
Supervisor’s Name and Contact Info (if applicable):*
Areas of Clinical Interest or Specialization (e.g., trauma, sexuality, gender identity, couples, adolescents, family systems):*
Briefly describe your counseling experience, including populations served:*
Are you currently employed elsewhere?*

YesNo
If Yes, where?
How many hours per week are you available to see clients?*
Preferred client populations:*

Adolescents (12 - 17)AdultsCouplesFamilies
Preferred availability:*

WeekdaysEveningsWeekends
Available Start Date*

MonthDayYear
Upload Your Resume*

Cancelof
Cover Letter*
References
Please provide two professional references and one pastoral or spiritual mentor reference.
Professional Reference #1: (Name, Relationship, Email, Phone)*
Professional Reference #2: (Name, Relationship, Email, Phone)*
Spiritual Mentor/Pastoral Reference: (Name, Church/Organization, Email, Phone)*
Theological and Mission Alignment
Rooted Counseling operates under the Institute of Biblical Sexuality and affirms both the Institute’s Statement of Faith and the Nashville Statement on Biblical Sexuality.
Have you read the Institute of Biblical Sexuality’s Statement of Faith and the Nashville Statement?*

YesNo
Do you agree with and commit to uphold these statements in your counseling practice?*

YesNoI have questions I’d like to discuss
Is there anything else you would like to share with us?
Signature & Agreement
By submitting this application, I affirm that all information provided is true and complete. I understand that Rooted Counseling is a gospel-centered counseling center operating under the Institute of Biblical Sexuality, and I agree to uphold its values and beliefs if invited to join the team.
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