Connected Family Services Questionnaire
Hello! Thank you so much for considering applying for the Counselor Outpatient position with Connected Family Services. To assist with making sure that we would be a match for each other, please complete this questionnaire.  
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Email *
Name *
First and last name
Phone number *
Which position are you applying for? *
Please enter date of licensure or expected/approximate date of licensure if you are pre-licensed *
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Are you paneled with any insurance? *
Required
Please tell us about your specialty/niche. How would you describe your ideal client? *
Can you describe your availability and your ideal schedule? (number of hours available to work per week and days/times available) *
Please tell us about your experience in Private Practice: *
Why do you want to work in a group practice? *
Do you have previous private practice experience? If yes, please tell us about your experience. *
Our practice is social justice oriented and is committed to being anti-racist. Ideal candidates are a resounding yes in this statement. Please let us know the last way you engaged in social justice or anti-racism work. (This can be books you read, trainings you attended, etc) *
We believe in being able to find balance between work and personal life. Our goal is to build a strong work community that fosters professional development. If hired at Connected Family Services, will you be working in your own private practice or another group practice? *
What sets you apart from others?  *
What are your long-term goals ( 1-3 years)? *
How would your colleagues describe your personality? *
Our practice puts a focus on community collaboration. We focus on helping the community by way of marketing, networking, and providing community speaking engagements. Are you comfortable with this? *
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