2024 Application - Counselor Position
Please answer the following questions and complete all steps. Incomplete applications will be discarded.

Sign in to Google to save your progress. Learn more
Due to potential conflict of interest, this position is only open to therapists that do not own and operate a private practice.  *
Required
Name: *
Email: *
Phone: *
Graduate Degree: *
Graduate University: *
Which of these active licenses do you have? *
Required
Which of these are you seeking? *
Required
Heena Khan specializes in Child/Person Centered Therapy and offers Supervision, are you interested in supervision with her? *
Required
How would you describe your theoretical orientation?  *
This position is not a good fit for therapists working at another private practice simultaneously. (possible exceptions only if you work with a non-profit org.) *
Required
What month and year did you receive your Associate/full licensure? *
If you are an LPC/LMFT-Associate, approximately how many hours of direct client services have you completed so far? *
Uplift Counseling Services is completely private pay, therefore your services must also be private pay/out of network. Does that work for you? *
Why are you currently seeking or changing employment? *
Why do you want to work in a private practice setting? *
What interests you about working at our group practice? *
Private pay practices can be slow and steady in growth, it is not a good fit for someone seeking immediate financial stability. *
Our ideal candidate is one that is ready to take their success in their hands. In what ways do you think you can take success in your hands as a private practice clinician? *
How many hours are you looking to commit in this new position? *
Required
How many clients are able to see comfortably per week? *
Required
Are you able to start part time and work up to full time status? *
Required
Are you able to provide services in-person (Allen, TX) AND via telehealth? *
Required
How many years of experience in counseling do you have, counting after graduation. *
Do you have any previous experience working in private practice? *
Required
How comfortable are you with marketing yourself in the community? *
Not comfortable at all
Very comfortable
What mental health conditions do you do your BEST work with? *
Which of the following are you looking to work with in this new position? *
Required
List any specialized trainings/credentials you have acquired. *
Do you have any formal Play Therapy training? If yes, please list them below. If no, type N/A. *
Please check one that is most true for you: *
Required
Do you plan to start your own private practice in the near future? *
Required
Do you have experience facilitating groups? *
What kinds of groups have you facilitated in the past? Type N/A if you don't have this experience. *
Are you willing and able to facilitate groups during the evenings or weekend? *
What days of the week and hours will you be available to work at the practice? *
Do you have evening and weekend availability? If yes, please list it below. *
What would be a comfortable start date for you? *
MM
/
DD
/
YYYY
Please provide 3 professional references. The list must includes the titles, location, email address and phone number for each reference. One of them must be a supervisor or a college professor that was able to supervise you. *
Please email your most current CV to info@uplift-counseling.com with the following in the subject line: 2023 Application for Counselor Position
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Uplift Counseling Services. Report Abuse
Google Forms