EMPLOYMENT QUESTIONNAIRE

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If hired, are you able to commit to a minimum weekly caseload of 25 client sessions? *
Have you worked as a psychotherapist for a minimum of 2 Years? *
Are you currently credentialed to provide services to any insurance panels? *
We are looking for clinicians who are able to work independently and follow directions easily, with minimal guidance. Do you feel comfortable working independently and being able to follow through on keeping notes accurate and timely, responding to emails in a timely fashion, and staying organized? *

Please tell us about any of your specialties, certifications, or niches that you have. List any certifications, previous experience, or any other information that informs us about your ability to work with that population(s). *

Are you available to work nights and/or weekends? Please discuss you ideal schedule. *

What are your long term goals (1-3 years out)? Personally and/or professionally. *

What can you bring to Life Change Therapy Now that sets you apart from other candidates? *

Tell us about your personality. How would colleagues describe you? *

Are you currently registered with Registered with CAQH?
Have you ever been disciplined, excluded from, debarred, suspended, reprimanded, sanctioned, censured, disqualified, or otherwise restricted in regard to participation with any private plans, federal, or state government health care plans or programs?
Have you ever had any professional liability actions (pending, settled, arbitrated, mediated, or litigated)?
Have you ever been convicted of a crime other than minor traffic offense?
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