Psychotherapist Application Questionnaire
Thank you for your interest in the Psychotherapist position at Rose Hanna Counseling Services. Please complete the below questionnaire as part of your application materials. If you haven't already, please email the founder, Dr. Rose Hanna, Psy.D your resume and cover letter to
Email address *
First and Last Name *
Are you fully licensed as an LCPC, LCSW, LMFT or Clinical Psychologist in the state of California? *
What is your NPI number?
What is your CAQH number?
Do you have previous private practice experience? *
If yes, please describe. *
Do you have experience providing long-term therapy with higher functioning adults? *
If yes, please describe. *
We are looking for a clinican who conducts individual and couples counseling. Do you have experience providing both? *
Why do you want to work in a group practice? Why Rose Hanna Counseling Services? *
Please tell us about your specialty if you have one. List any certifications, previous experience, or any other information that informs us about your ability to work with that population(s). *
Our clinicians are able to work independently 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 notes accurate and timely, responding to emails in a timely fashion, and staying organized? *
What are your long term goals (1-3 years out)? Personally and/or professionally. *
What can you bring to Rose Hanna Counseling Services that sets you apart from other candidates? *
What is your availability? *
Please check all that applies.
Tell us about your personality. How would colleagues describe you? *
Please upload your resume and references
Please upload your cover letter.
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