About you

We read every application, and we will tell you where you stand.

Name*

First Last

Email*

Phone Number*

Which position are you applying for?*

Clinical Supervisor (LPC, LMFT or LCSW)
Licensed Clinician (LPC, LMFT, LCSW or LIAC)
Associate Clinician (LAC, LAMFT or LMSW)
Graduate Clinical Intern

Licensure

Which Arizona license do you hold?*

Interns and license-eligible applicants: choose the closest option.

Licence number

Leave blank if you are not yet licensed.

Are you qualified to provide clinical supervision under the Arizona Board's clinical supervisor rules?

Yes
Not yet, but I can be before my first supervisee is assigned
No

Not being qualified yet is not disqualifying.

Are you listed on the Arizona Board's Clinical Supervisor Registry?

Yes
No

Statement of faith

These are requirements of every clinical role here, not preferences. Our faith is the fuel for our service, not a prerequisite for anyone's care.

Do you freely and fully affirm that the Bible is the inspired, trustworthy, and authoritative Word of God?*

Yes
No

Do you freely and fully affirm the Essential Truths of Christianity as described in the Athanasian Creed?*

Yes
No

Do you freely and fully affirm that Biblical marriage can only be between one biological man and one biological woman?*

Yes
No

Are you willing to practice under the code of ethics of the American Association of Christian Counselors, even if you are not a member?*

Yes
No

References

These are continuing conditions of the role, refreshed annually for as long as you hold it, not a one-time hiring screen. When you submit this application we email each person below their own set of questions, and copy you so you can follow your application's progress.

Are you willing to provide a pastoral reference annually, as a condition of both hiring and continued employment?*

Yes
No

Pastor's name*

Pastor's email*

Church name

Are you married?*

Yes
No

One who would care for others must first manage his or her own household well (1 Timothy 3:4–5). If you are not married, name instead the person who knows your household life best.

Spouse's name*

Spouse's email*

Household reference: name*

Household reference: email*

Your academic program

Program and school*

Faculty or program director: name*

Faculty or program director: email*

Your program's written confirmation that this placement is approved

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 64 MB.

If you do not have it yet, you can send it later.

Credentialing (optional)

Only useful for speeding up payer credentialing after a hire. Nothing here is required, and leaving it blank does not affect your application.

Do you have a completed CAQH provider profile?

Yes
No

CAQH ID number

Do you have an NPI number?

Yes
No

NPI number

Your application

Résumé or CV*

Accepted file types: pdf, doc, docx, Max. file size: 64 MB.

Tell us about yourself*

A few paragraphs is plenty. Tell us your licensure status; what your clinical work has mostly been; and, if you are applying to supervise, the specialty you would want to build a service line around, and what you would want to be true about a supervision program before you would put your name on it.

Professional profile photo

Accepted file types: jpg, jpeg, png, Max. file size: 64 MB.

Optional.