WELLNESS AND RECOVERY HUB

WELLNESS AND RECOVERY HUB
Therapist Job Application
Thank you for your interest in joining our team. Complete applicable fields; use N/A as needed.

To apply for this possion you must have an active license to practice in Utah.
Contact information, availability, and professional qualifications

Please do not include client information, SSNs, banking details, or account passwords.
Contact information
Full name

First NameLast Name
Preferred name (optional)

First NameLast Name
Email address
example@example.com
Phone number
Format: (000) 000-0000.
City and state

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Earliest available start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position and availability
Position: Part-time | Telehealth only
Desired hours per week
Available days and times (include evenings/weekends)
Licensure and education
License type (e.g., LCSW, CSW, CMHC, ACMHC, LMFT, AMFT)
Licensing state(s)
License number(s)
Expiration date(s)
Highest relevant degree, field of study, and school
Applicants awaiting licensure: list your anticipated license type and expected approval date above.

WELLNESS AND RECOVERY HUB Therapist Job Application
Professional fit, references, and applicant acknowledgment
Additional relevant employment: employer, role, dates, and responsibilities (or see resume)
What draws you to Wellness and Recovery Hub, and what would you bring to our team?
What support or work environment helps you do your best clinical work?
Professional references
Provide two professional references. Please obtain their permission before listing them.
Reference 1: name, professional relationship, phone, and email
Reference 2: name, professional relationship, phone, and email
May we contact your current employer?
Resume and acknowledgment
Please provide your current resume with your application.

I certify that the information I have provided is accurate and complete to the best of my knowledge.
I understand that my professional qualifications may be verified during the hiring process.
Resume Upload

Upload your current resume here.
Cancelof
Signature
Applicant name (typed acknowledgment)

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Thank you for taking the time to apply. We look forward to learning more about you.
Wellness and Recovery Hub | Employment application
3 / 3
Should be Empty:

WELLNESS AND RECOVERY HUB Therapist Job Application