info@newbeginningrtc.com

Licensed Clinical Therapist

Deliver trauma-informed therapy to adolescents through individual, group, and family sessions. As a Licensed Therapist, you’ll play a key role in each resident’s healing journey, working in a supportive clinical setting alongside passionate professionals.

Employment Application Form

SECTION 1. Applicant Information

Full Name

Home Address

Number of years at this address

City

State

Zip

Daytime phone

Evening phone

Mobile phone

Social Security Number

Driver's License (State/Number)

Date of Birth

Email address

Do you have any conditions which would require job accommodations?

Have you ever been convicted of a crime?

SECTION 2. Emergency Contact; who should be contacted if you are involved in an emergency?

Contact Name

Relationship

Daytime Phone

Evening Phone

SECTION 3. Job Positition Applied Fo

Salary Desired

Are you at least 18 years old?

SECTION 4. Availability

If you are offered employment, what days, hours or shift are you available to work?

What day can you start to work?

SECTION 5. Applicant's Skills

SECTION 6. Applicant Employment History

Employer Name

Supervisor Name

Dates of Previous Employment History

City

State

Zip

Job Duties

Reason for Leaving

Employer Name

Supervisor Name

Dates of Previous Employment History

Phone Number

Address

City

State

Zip

Job Duties

Reason for Leaving

SECTION 7. Applicant's Education and Training

College/University Name

College/University Address

Year Graduated

Degree Earned

High School/GED Name

High School/GED Address

Year Graduated

Degree Earned

Other Training (graduate, technical, vocational)

Please indicate any current professional licenses or certifications that you hold

Military Service

Branch

SECTION 8. Reference

Name

Address

City

State

Zip

Telephone

Relationship

Name

Address

City

State

Zip

Telephone

Relationship

Name

Address

City

State

Zip

Telephone

Relationship

Acceptance

Certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Leon Valley New Beginning RTC. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to communicate information fully and freely regarding my previous employment, attendance, and grades. I authorize those persons designated as references to communicate information fully and freely regarding my previous employment and education.

Licensed Clinical Therapist

Employment Application Form

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