Employment Form | DSA Counseling Works

D.S.A. Counseling Works, LLC considers applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual preference, marital or veteran status, or any other legally protected status.

Position Applying For *

First Name *

Last Name *

Email *

Email

Confirm Email

How did you hear about us? *

Where did you see our advertisement?

Who referred you to us?

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone *

Alternate Phone

Best time to contact you *

Emergency Contact Person

Emergency Contact Phone

If less than 18 years of age, can you provide required proof of eligibility to work? *

Have you ever been employed by D.S.A. Counseling Works, LLC? *

If yes, when?

Are you currently employed? *

If yes, may we contact your employer?

Have you ever filed an application with D.S.A. Counseling Works, LLC? *

If yes, when?

Do any friends or relatives work for D.S.A. Counseling Works, LLC? *

If yes, his/her name and relation

Are you prevented from becoming lawfully employed in this country due to VISA or Immigration Status? *

Proof of citizenship or immigration status will be required upon employment.

Have you ever been convicted of a crime *

If you have been convicted of a crime, please list your offense(s), date(s) of offense, city/state, and disposition.

Date you are available to start work: *

Salary Desired *

Hours of Availability: *

Are you currently in lay off status and subject to recall? *

Can you travel if the job requires it? *

Please upload your Resume/CV *

Drop your file here or click here to upload You can upload up to 2 files.

Education

High School Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Years Completed

Diploma/Degree

College/University

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Course of Study

Years Completed

Degree

Graduate/Professional

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Course of Study

Years Completed

Degree

Other Schooling

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Course of Study

Years Completed

Degree or Certification

Work Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may include organizations that indicate any legally protected status.

Name of Employer

Supervisor's Name

Job Title

Date of Employment Start

Date of Employment End

Work Performed

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

May we contact?

Rate/Salary

Reason for leaving

Name of Employer (copy)

Supervisor's Name (copy)

Job Title (copy)

Date of Employment Start (copy)

Date of Employment End (copy)

Work Performed (copy)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

May we contact? (copy)

Rate/Salary (copy)

Reason for leaving (copy)

Skills & Training

List below any specialized training you have had for dealing with children with emotional, behavioral and/or mental health issues:

Write below any additional information you have or any supplementary skills you possess that enhance your ability to work with children and adolescents with behavioral, emotional, or mental health issues.

Confidential Request for References

Please complete this form for all requested previous employers.

Attention

Title

Company

Applicant's Name

Date of Employment (from:)

Date of Employment (To:)

Last Pay Rate

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Name used while employed

Applicant's Signature

I hereby authorize you to release to D.S.A. Counseling Works, LLC any information requested concerning my employment with this company/organization.

Today's Date

Therapist Written Interview

This interview is designed to help me get to know you better. Some questions have specific answers, while others are a matter of opinion. We, at D.S.A. Counseling Works, LLC, hope that you enjoy the process and that you are a good match for our company.

Can you tell me about your training as a therapist (where you received it, what type of training)?

Which population would you like to work with, and have you ever worked with this population before?

Given your orientation, describe how you have worked with or would work with a child from this population and what the process toward improvement would look like for this child.

Describe what is meant by culturally competent treatment?

How do you ensure that you keep up with your profession?

What do you believe are your personal/professional strengths and weaknesses?

Describe for me how you ensure that your weaknesses do not interfere with your work?

Tell me what a DAP note is and how one is written?

A youth is screaming obscenities at their parents, how do you respond?

As a therapist, your role is to implement each client’s individualized treatment goals. You have been assigned an eleven-year-old female with issues of anger and low frustration tolerance. What types of activities might you find appropriate to address her target areas?

Specialties & Skills

PLEASE CHECK ALL THE AREAS THAT ARE YOUR SPECIALTIES, SKILLS, KNOWLEDGE, and/or EXPERIENCES

Applicant's Statement

I certify that the information and answers given here are true and complete.

I authorize the investigation of all statements contained in this application for employment as may be necessary to determine an employment decision.

This application for employment shall be active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicants are being accepted at the time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature. This means that the employee may resign at any time and that the employer may discharge them at any time with or without cause.

In the event of employment, I understand that false or misleading information given in my application and interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of my employer.

Signature *

Interested in joining our team?

Education

Work Experience

Skills & Training

Confidential Request for References

Therapist Written Interview

Specialties & Skills

Applicant's Statement

Make an appointment

Insurance Policy

Insurances Accepted

Office Hours

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