Therapist (LLMSW, LMSW, LPC)

Contact Information

Are you 18 years or older? (Yes/No)

First Name*

Middle Initial*

Last Name*

Street Address*

City*

State*

Zip Code*

Email*

Phone*

General Information

Are you legally eligible to work in the United States? (Yes/No)*

Yes No

Have you ever been convicted of a felony? Type Yes or No*

Do you have a valid driver’s license? (Yes/No)*

Yes No

How did you hear about this job opening?*

Which Schedule would you prefer for work?*

Full Time Part Time 1099/contractor

If hired, what location would you prefer to work:*

Marquette Escanaba Houghton

If hired, how long do you wish to work for FBS?*

Education History

Which degree are you working towards or currently hold?*

What type of state of MI Therapy license do you hold?LLMSW, LMSW, LPC?*

Please type in full or limited license number (LLMSW, LMSW, LPC). If you do not currently have a license but are currently enrolled in a Master's Program to pursue licensure please type in expected graduation date.*

Name and location of school*

Number of years attended*

Did you graduate?*

How many years of experience do you have working post license?*

List any specialty trainings you have completed and level of experience*

Behavioral and Situation Questions

What is your therapeutic area of expertise/ focus/ interest?*

Provide examples of maintaining workplace privacy, confidentiality and ethical standards regardless of financial, social and other pressures?*

How do you manage your workload when you have competing deadlines and multiple clients who need attention?*

Describe a situation where you needed to understand someone’s perspective that was vastly different from your own.*

Provide an example of a time where you managed an unexpected situation/responded to an emergency?*

Tell me about a time you developed and maintained successful relationships at all levels within an organization?*

Work Experience

Do you have experience working in an outpatient clinical, behavioral, or counseling therapy environment?*

Yes No

Once fully trained, this position works with clients in a variety of settings including our clinic, the community, and in their homes. Are you willing and able to work in these environments?*

Yes No

Please list your work experience, beginning with your most recent position:

Job title, employer name, address, city, state, and zip*

Phone number of employer*

Name of last supervisor*

Start and end dates*

Starting and final salary or rate*

Description of your responsibilities*

Was your termination voluntary or involuntary? Reason for leaving?*

Please list two professional references who have supervised your work or worked directly with you (do not include relatives):

Reference 1: Name, Position, Company, Phone Number*

Reference 2: Name, Position, Company, Phone Number*

Optional Reference 3: Name, Position, Company, Phone Number*

CONTACT US