Followup Application

Followup Online Application

Which position are you applying for? *

Name *

First

Last

Phone Number *

Email *

What is your desired amount of clinical hours per week? *

Less than 5 5-10 10-20 More than 20

What is your desired amount of pay per clinical hour? *

Less than $40 $40-$75 $75-$100 More than $100

Are you comfortable using an EHR (Electronic Health Record) system? *

Yes No I am open to learning.

Do you own a computer or tablet you can use for work purposes? *

Yes No I can purchase one in the future.

Do you carry malpractice insurance? *

Yes No I am willing to buy coverage in the future.

We are exclusively a fee-for-service practice and do not work with insurance. Are you willing to help promote your services to the community? *

Yes No I am willing to learn.

Are you comfortable counseling individuals of another faith, sexual orientation, race, and/or background? *

What is your approach for integrating faith into counseling? *

What training and licensure or certification in counseling have you received? *

What formal theological training have you received? *

What do you enjoy the most about being a counselor? *

What is your personal testimony or faith journey? *

When are you available to start? *

Submit

9299 W. Olive Suite 212
Peoria, Arizona 85345 | Map >
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