Employment Questionnaire
Hi! Thank you for taking the time to apply for a therapist position at Bright Light Counseling Center. In order to assure that we are a good match and to streamline the process, please complete the questions completely and accurately. Thank you!
Your Full Name *
E-mail Address *
Are you fully licensed as an LPC or LCSW or LMFT or Psychologist in the state of Illinois or Texas? *
If so, what is your License Number?
If you are fully licensed in another state, please indicate State(s) and License Number(s) below.
Do you have a CAQH Profile? *
Do you have an NPI Number? *
Which insurances are you paneled with? *
Are you interested in: *
Are you willing and able to work some evenings and/or Saturday Mornings? *
Describe your ideal schedule *
Do you have previous private practice experience? *
If yes, describe your previous practice experience.
Why do you want to work in a group practice? Why Bright Light Counseling Center? *
What are your expectations or hopes for becoming a part of our group practice? What are looking for in a potential employer?
Why are you interested in group practice over opening your own private practice? *
Our practice culture is collaborative, supportive, and social. Tell how you envision fitting in with this culture? *
Clinicians who thrive at our practice work independently, reach out for support, engage in consultation and collaboration, and follow directions easily. Do you feel comfortable working independently and being able to follow through on scheduling your existing clients, taking copays or payment, keeping accurate and timely documentation, responding to emails in a timely fashion, and staying organized? *
Please tell us about your specialty/niche(s). Include certifications, specialized training, previous experience, and other information that informs us about your ability to work with that population(s). *
What would your clients say that they like about you or your practice? *
How would colleagues and/or supervisors describe you? *
What are your personal career goals/goals in private practice? *
Where do you see your career in the next year or 2? *
What can you bring to Bright Light Counseling Center that sets you apart from other candidates? *
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