Mental Health Therapist
Center for Anxiety and Behavior Management (Chester, NJ)
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First Name *
Last Name *
Phone Number *
Email Address *
Where did you see our ad? *
Address
Highest Degree Attained (please type the specific name of the degree) *
Specific NJ License Currently Held and License #: *
Experience *
Cover Letter *
What date did you earn your license? *
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Explain what draws you to using CBT and or other evidence based methods? *
What training do you have in CBT and/or specific books you have read in this area? (If somewhat limited, describe your motivation/willingness to pursue this). *
Describe how you would work with someone with panic attacks, social anxiety, or OCD (you choose and SPECIFY which disorder) and your experience helping clients in this area. If you have limited experience in this area, please discuss your approach with clients who have depression, anxiety problems, or behavioral issues. *
What age groups and types of clients do you have experience working with (select all that are applicable)? *
Required
With which age groups and types of clients would you prefer to work with at Center for Anxiety and Behavior Management (select as many as you would like)? *
Required
What days and hours are you available and interested to work? *
What interests you in working with Center for Anxiety and Behavior Management? What are your career goals? *
Do you currently have your own practice? If so, are you planning on maintaining this if you are employed with Center for Anxiety and Behavior Management? *
What are your hourly salary requirements? You must specify a dollar amount or an hourly range to be considered. *
Date of Graduation from Graduate School: *
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Number of Years in Practice: *
During the past 5 years, have you had any claims made against you or are aware of any circumstances which may result in a claim being made against you arising out of services for others? *
Have you ever had your license revoked or suspended, been sanctioned by or are being reviewed by any Professional Ethics Body, State Licensing Board, or other regulatory body? *
During the past 5 years, have you ever had professional insurance been declined, canceled, or refused renewal by an insurance company? *
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