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Employment Application
Demographic and License Information
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MM
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DD
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Name *
Email Address *
Phone # *
Address *
Where did you attend graduate school? When did you graduate and with what degree? *
State of Texas License and License # *
Do you hold counseling license in other states? If so, describe. *
How long have you been providing counseling services to clients? (Post Graduation) *
Are you looking for Full-Time (20-25 weekly billable hours) or Part-Time (10-15 weekly billable hours)? *
What days and times are you available to see clients (either in person or telehealth)? *
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