Application for Hire -Site Supervisor

Site Supervisor Initial Application for Hire

Please also email your resume to our Clinical Director, Alyssa Theis at [email protected] in combination with submitting this application.

First Name *

Last Name *

Phone Number *

Email *

Licensure

Please note that we only hire those who have a California license in good standing.

License/Registration Number *

Has your license/registration to practice in any jurisdiction ever been limited, suspended, or revoked? *

Has there ever been legal action against you in your role as a therapist? *

Have you ever been denied membership or renewal thereof or been subject to disciplinary action in any professional organization or licensing board? *

Elaborate on any "yes" answers from above.

Professional Experience

Please list all therapeutic modalities in which you are trained (CBT, Cognitive Processing Therapy, Emotion-Focused Therapy, Acceptance and Commitment Therapy, Prolonged Exposure Therapy, Mindfulness, Dialectical Behavior Therapy, EMDR, Other): *

Have you participated in any certificated trainings? If yes, which trainings? *

Please indicate all client issues in which you are trained and comfortable working (ie depression, anxiety, panic attacks, OCD, personality Disorders, trauma, PTSD, combat (military), chronic pain, medical issues, sexual Abuse, physical Abuse (experienced during childhood), domestic violence, veterans, couples therapy, relationship issues (individual), perinatal mood and anxiety disorders, grief and loss, other) *

License Expiration Date *

Do you have experience with military/Veterans? If so, please describe: *

Do you have any bilingual abilities? If so, please elaborate.

Leadership Experience

What prior supervisory/leadership experience do you have, if any? *

What makes you interested in the Site Supervisor position? *

On a scale of 1-10, how would you rate your leadership skills? *

On a scale of 1-10, how detail-oriented are you? (10 being most detailed) *

Clinical Experience Desired

What are your professional goals in the next 3-5 years? *

Do you have your own private practice or work in another group private practice? Are you intending to maintain your employment at another practice while employed at FWC? *

Do you have any days off or vacation scheduled in the next 6 months? *

Thank you so much for taking time to apply for a position with us! Upon reviewing your responses and resume, if you appear to be a good fit we will contact you to schedule a 20-30 minute initial video interview. Initial interviews are conducted by our Clinical Director.