Interview Questionnaire
Applicant First Name
*
Applicant Last Name
*
Email
*
Notes
What’s your educational and work background?
Undergraduate School
Graduate School
Work history
What License Do You Have?
LMHC
LICSW
LADC
Pre-LMHC
Pre-LICSW
Other License
No elements found. Consider changing the search query.
List is empty.
Other License
Life experience:
Tell me what led you to become a therapist
Help me get to know you better
Where do you live?
Tell me about your Family/Hobies/Interests
What is your clinical speciality?
What populations do you serve?
Young Children 3 to 6
Children 7 to 13
Adolescents 14 to 17
Young Adults 18 to 25
Adults 26 to 40
Adults 41 to 60
Adults 61 and Older
What is your scheduling availability?
What would be your preferred Start Date?
POST INTERVIEW
Is the applicant a viable candidate
Yes
No
Later
How is the applicant different from, or an asset to, our other clinicians
Employee Type
Part Time Contractor
Full Time Employee
PT transitioning to FT
Part Time Contractor start date:
Full Time start date
Pt transitioning to FT Full Time start date:
PT Salary
$
Mentoring Therapist Assigned
Amy Leek
Amy Griffin
Cameron McCauley
Charlene Flynn
Charlotte Coe
Danielle Lally
Haleigh Creamer
Heather Skutnik-Sheffield
Jaclyn McMurray
Jamie Jackson
Katie Fauth
Liz Freedman
Meridith Wirtz
Rachel Feddor
Rebecca Rubenstein
Robert Mudge
Samantha Johnson
Sarah Kristy
Shannon Devaney
Victoria Martin
No elements found. Consider changing the search query.
List is empty.
Supervising Clinician for PLC’s Only
Amy Leek
Amy Griffin
Charlene Flynn
Charlotte Coe
Cameron McCauley
Danielle Lally
Haleigh Creamer
Heather Skutnik-Sheffield
Jaclyn McMurray
Jamie Jackson
Katie Fauth
Liz Freedman
Meridith Wirtz
Rachel Feddor
Rebecca Rubenstein
Robert Mudge
Samantha Johnson
Sarah Kristy
Shannon Devaney
Victoria Martin
No elements found. Consider changing the search query.
List is empty.
Full Time Employee Salary
$
Next Steps Approved
Send Contracts
Send Contracts
Provider Contract
Pre-Licence Offer Letter
Licenced Offer Letter
LMHC Supervision Contract
LICSW Supervision Contract
Supervisor Contract
State Release
Admin Steps
Admin Steps
Create Google Workspace Account
Assign Google Voice Phone Number
Email Workspace Details
Create Psychology Today Profile
Create Welcome Letter
Submit