Do you possess a valid license as a Licensed Clinical Social Worker (LCSW), a Marriage and Family Therapist (MFT), or a Licensed Professional Clinical Counselor (LPCC) issued by the California Board of Behavioral Sciences?
Yes
No
If you answered "Yes" to the question above, please list the type of license you have and provide your license number and expiration date in space below.
2.
PATTERN II
Do you possess a valid license as a Psychologist issued by the California Board of Psychology?
Yes
No
If you answered "Yes" to the question above, please provide your license number and expiration date in the space below.
FOR BOTH PATTERNS
3.
To qualify, applicants must have graduated with a master's degree or doctorate from an accredited college or university. Please indicate if you possess a master's degree in one of the following disciplines:
Master's - Social Work
Master's - Counseling
Master's - Psychology
Doctorate - Psychology
Other
None
Provide the name of the accredited college/university attended.
If you selected "other" in question #1, include the discipline/field for which you obtained your Master's degree.
4.
Do you have at least two (2) years of full-time paid progressively responsible licensed casework experience as an LCSW, MFT, LPCC or Psychologist, which included counseling or therapy in a clinical or treatment setting?
Yes
No
5.
Do you have at least one (1) year of full-time paid supervisory experience as a as a Licensed Clinical Social Worker (LCSW), Marriage and Family Therapist (MFT), Licensed Professional Clinical Counselor (LPCC), or Psychologist?
Yes
No
Please ensure this is CLEARLY demonstrated in the Employment Experience section of your application.
Note: resumes will not be accepted in lieu of a completed application.
6.
Candidates must possess and maintain a valid California Driver's License. Provide your valid California driver's license number and expiration date.