Work with US!

Please correct the errors described below.

Name

First Name

Last Name

Email address

Phone Number

License Type

LPC LPCC LSW CSW MFT MFTC PSY PSYC Other

If provisionally licensed (licensed candidate), when do you expect to be fully licensed?

Type of work desired

1099 Contract W2 Employee

Comments on work type

Are you available to work at least 10 hours a week? Clinical contact hours

Yes No

Do you plan to be employed by another private practice, own your own private practice, or work through technology owned virtual platforms (i.e., BetterHelp, TalkSpace, Sondermind, etc) during your work with Along Your Journey?

Yes No

Do you speak a language other than English?

Yes No

If yes, what other languages?

I am social justice oriented, LGBTQIA+ affirming, and anti-racist I can document cultural competency training and experience

Yes No

Are you comfortable working with children 5-12 years old?

Yes No

Are you comfortable working with couples?

Yes No

Are you comfortable working with families?

Yes No

Please upload you Resume/CV

Add file

Please upload a file

Please upload your Active License/s

Add file

Please upload a file

Additional notes or comments?

Were you referred to apply by someone working with Along Your Journey? If so, what is their name?

Staff, Employee, Contract Worker Name Only

Please note: Incomplete applications will not be accepted nor will we acknowledge them.

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