Counselor Application

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Pathways Family & Community Services is an Equal Opportunity Employer.

Email *

Counselor Name *

First and last name

Phone Number *

Address *

License Number (if applicable) *

If not fully licensed, expected date of becoming fully licensed *

YYYY

List your current or most recent employer and why you are seeking new employment *

Describe any experience that relates to work in a private practice *

List your availability to work (days and times). Note: Pathways FCS is open 9AM-7PM Mon-Thursdays. Fridays - Closed for Provider Self-Care Day *

Are you looking for full time or part time work? *

Full time (30 sessions or more per week)

Part time (20 sessions per week)

Less than Part Time (less than 15 sessions or less per week)

Languages Spoken *

Why do you want to work in a private practice? *

What are your long term professional goals? *

How did you hear about Pathways FCS? *

When can you start? *

YYYY

List treatment modalities that you use *

Have you worked more with children, adults, or families? What is your preferred specialty? *

Please check the boxes that apply to you: *

I am able to commute to Stafford, Virginia

I am available to work on Saturday

I am available to work evenings only

Required

Send me a copy of my responses.

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