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Application form

Clinician Job Application Questionnaire

Thank you for your interest in joining Bedrock Counseling. Please complete the form below to help us learn more about your clinical background, experience, and alignment with our practice philosophy.

Section 1: BASIC INFORMATION

Are you legally authorized to work in the United States?
Yes
No

Section 2: LICENSURE & CREDENTIALS

What is your current professional status?
Fully Licensed Clinician
Pre-Licensed / Registered Intern
Graduate Student Completing Internship
Professional License or Registration Type
State of Licensure
Years of Clinical Experience
0–1 years
2–3 years
4–6 years
7+ years

Section 3: CLINICAL EXPERIENCE

What populations do you primarily work with? (Check all that apply)

Section 4: TRAUMA & EMDR EXPERIENCE Bedrock Counseling places a strong emphasis on trauma-informed care.

Have you received EMDR training?
Yes – EMDR Trained
Currently in EMDR Training
Not yet trained but interested in training
No interest in EMDR training

Section 5: PRACTICE FIT

What would an ideal caseload look like for you?
10–15 sessions per week
16–20 sessions per week
21–25 sessions per week

Section 6: PROFESSIONAL HABITS

Section 7: FAITH & CLIENT WORLDVIEW Bedrock Counseling is a Christian faith-based practice. Some clients choose to incorporate spirituality or faith into their therapeutic process.

Section 8: AVAILABILITY

Are you applying for:
Full-Time
Part-Time
What days are you typically available to see clients?

Section 9: FINAL QUESTIONS

Section 10: RESUME UPLOAD

Section 11: ACKNOWLEDGMENT I confirm that the information provided above is accurate and reflects my professional background.

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