Application Form

Full Name

Phone

What are your current credentials in the states that you are licensed?

What states are you licensed in?

List the primary treatment approach(es) you use. Which approach do you most prefer and why?

What client populations are you interested in, and do you have a specific niche or specialty that you focus on?

Are there any populations that fall outside your preferred scope?

How many clients would you like to see a week?

Please note that clinicians are expected to maintain a minimum caseload of 10 clients per week for part-time positions and 20 clients per week for full-time positions.

Please provide your anticipated weekly availability as specifically as possible.

Example: Mondays 9:00 a.m.–2:00 p.m., Wednesdays 3:00–7:00 p.m.

Please share three words you would use to describe yourself.

Why are you interested in working at Queen Village Therapy?

How did you learn about Queen Village Therapy?

Resume and Cover Letter