Cultivate Wellness Counseling Contractor Interest Form
We’re hiring! CWC is excited to grow our team with someone who shares our passion for compassionate, client-centered care :)
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Full Name: *
Email: *
Phone Number: *
License Type & Number: *
If you are provisionally licensed, how many hours do you have left to achieve full licensure, and who is your supervisor?: *
Are you Bilingual? If so, what languages do you speak fluently, and how comfortable would you feel doing therapy in these languages? *
What are your areas of specialty? Are you looking to add any special certifications?  *
Are there any populations that you do not feel comfortable working with, for any reason? *
How many sessions per week are you hoping to offer?
 *
What would your ideal schedule look like? *
When would you like to start? *
Are you currently paneled with any insurance companies? If so, which ones? *
Will you be bringing any clients with you to Cultivate Wellness Counseling if you are offered the position? *
Have you or anyone in your immediate family received therapeutic services from any clinician at Cultivate Wellness Counseling?: *
At Cultivate Wellness Counseling, we value honesty, teamwork, integrity, genuineness, trust, justice, and compassion. Can you share how these values show up in your work with clients or colleagues, and give an example of how you've embodied one or more of them in your professional life. *
What qualities/offerings would you be looking for from Cultivate Wellness Counseling if you were to be offered this position? *
What about this position is of interest to you?
 *
What do you know about Cultivate Wellness Counseling and its values?
 *
Any other comments, questions or concerns? *
At the completion of this form, please email your resume to: cecilia@cultivatewellnessilm.com and hang tight for next steps! Again, thank you for your interest in Cultivate Wellness Counseling!
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