Employment Application
  1. Your Name (required)
  2. Your Phone
  3. Email Address (required)
  1. Degree
  2. Licensure
  3. Years Licensed
  4. Briefly describe your clinical interests (populations, presenting issues) and the approach you take in your clinical work
  5. Heartland Counseling is a faith-based counseling center that is trusted and respected by the faith communities in the area, could you please describe your experience with spiritual integration as a part of your clinical work?
  6. What are your areas of strength as a therapist?
  7. Part of the responsibility of being a clinician at Heartland Counseling is building relationships in the community where we work. Could you describe the experience you have had in this area, and how you would do this if you worked here?
  8. Why do you want to be a part of the team at Heartland Counseling? What else do you think is important for us to know about you?

References: Please fill in the following in order from MOST CURRENT to OLDEST employer or training site:

Site 1:
  1. Place of employment: (name and address)
  1. Date of employment: (month/year – month/year)
  1. Name and degree of supervisor:
  1. Contact information for supervisor:
  1. Is it ok to contact this supervisor? (if no, please explain)
Site 2:
  1. Place of employment: (name and address)
  1. Date of employment: (month/year – month/year)
  1. Name and degree of supervisor:
  1. Contact information for supervisor:
  1. Is it ok to contact this supervisor? (if no, please explain)
Site 3:
  1. Place of employment: (name and address)
  1. Date of employment: (month/year – month/year)
  1. Name and degree of supervisor:
  1. Contact information for supervisor:
  1. Is it ok to contact this supervisor? (if no, please explain)
  1. Resume Upload

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