Mental Health Pre-Licensed Provider Job Application
Hello! Thanks for taking the time to apply for a pre-licensed therapist position at Legacy Counseling Service. To streamline the process and learn more about you, please fill out this questionnaire. Thank you!
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Email *
First and last name *
Phone Number *
How did you find Legacy Counseling as a possible place to work? *
Please watch this brief video about Legacy Counseling Service before completing the rest of this form.
What masters or doctoral program are you currently in and what school is it associated with?  What year are you in the program and how many years, in total, does your program last? *
Have you passed the state licensing exam? If not, when will you take it? *
Do you have a clinical supervisor relationship established yet?  If so, please provide their name, licensure type, phone number, and email address. *
What age range and presenting problems are you interested in focusing on at Legacy Counseling Service? *
Please tell us about your clinical interests. List any certifications, trainings, previous experience, or any other information that informs us about your ability to work with that population(s). *
Are you interested in offering group therapy as part of your practicum? If so, please tell us what type of groups you are interested in offering. *
Are you interested in learning/offering virtual groups, in addition to possibly doing in-person groups? *
Are you available and willing to see clients until 7 or 8 pm during the week?  This is not a deal breaker, but we do have a great need for evening therapists. *
Required
Are you available and willing to see clients one weekend morning or afternoon? Again, this is not a deal breaker, but we do have a great need for this. *
Please discuss your ideal schedule (we try to make accommodations but ultimately are looking for a win-win between what we need and you need). 

Please answer the following: 1) the number of clients you would like to see per week, 2) the times you work best, and 3) the days of the week you like to work.  
 *
Do you have previous private practice experience? If so, please tell us about it. *
Our practice is very collaborative. We focus on helping the community by way of marketing, networking and providing community speaking engagements. Are you comfortable with contributing to this as part of your practicum experience? *
Not at all comfortable
Very comfortable
How comfortable are you with discussing spirituality in therapy if this is of importance to the client? *
Not at all comfortable
Very comfortable
List three references who know your clinical work well.  List their name, their phone number and email address, and their relationship with you.
Why are you interested in working at Legacy Counseling Service? *
What are your long term goals (1-3 years out)?   *
What can you bring to Legacy Counseling Service that sets you apart from other pre-licensed candidates? *
Tell us about your personality. How would colleagues and supervisors describe you? *
Please email a cover letter and your resume to drleedy@legacycounselingservices.com. *
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