Career Application Submitted

First Name

Last Name

Email Address

Phone

Type of License (including hours remaining if you're working towards full licensure)

Please provide a provisionally licensed clinician's current supervisors name.*

Location Applying For Location Applying For Lowndes County, Georgia

Position Applying For Position Applying For Therapy (Master's degree req'd) Paraprofessional (Bachelor's degree req'd)

Are you currently credentialed with any insurance companies, EAP's, or government payers? Are you currently credentialed with any insurance companies, EAP's, or government payers? Aetna BCBS Tricare

Are there any prohibitions or barriers based on your past, current, or future employment that will prohibit you from serving any populations? Are there any prohibitions or barriers based on your past, current, or future employment that will prohibit you from serving any populations? Yes No

Tell us about your clinical specialties, area of focus, and populations served.*

CFL believes that good therapy sometimes exists in ethically uncomfortable areas that require wrestling and consultation. Tell us about a time where you had to walk that line.

Are there any populations that you're opposed to working with from a moral, safety, or competency point of view?

What are your views on therapist self-disclosure as part of the clinical relationship with clients?

If CFL had the opportunity to provide school-based services either in person or via telemed, would you be interested in these opportunities? If CFL had the opportunity to provide school-based services either in person or via telemed, would you be interested in these opportunities? YES NO MAYBE

Tell us what you know about CFL and why you think you'd be a good fit in our practice culture.*