Colorado Coalition for the Homeless - Behavioral Health Clinician

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C&P Application Questions

Referral - Where you referred by anyone currently working at CCH? If so please include their full name.✱
Have you ever worked for CCH or RPMC before? If yes, when and which department?✱
Are you or any of your immediate family members currently or within the past 12 months a client, patient, or resident of the Colorado Coalition for the Homeless?✱
Are you able to perform all requirements for the position as outlined with or without accommodations? If no, please provide additional information.✱
If "No" please provide additional information below:
What are your pay and/or salary expectations?✱
Do you hold professional licenses and/or certifications?✱
Do you currently hold a Colorado professional license?✱
Which of the following licenses do you currently hold if applicable?✱
- LSW
- LPCC
- LPC
- LCSW
- LPN
- RN
- PHARM-D
- PSY-D
- LMFT
- LAC
- MD
- DO
- RT
- RP
- PT
- OD
- MFT
- LVN
- DMD
- AEC
- ACU
- RDH (DH) AAS
- CNS
- CAC-III
- CAC-II
- CAC-I
- RXN) PA (PA-C)
- DNP
- FNP
- NP(APN
- DDS
- DEA
- Other
- None
Which of the following Certifications do you currently hold if applicable?✱
- DA
- MA
- CPR
- BLS
- EMT
- CB
- CBA
- Other
- None
If "Other" selected for Licensure and/or Certification, please list below:

Additional information

U.S. Equal Employment Opportunity information (Completion is voluntary and will not subject you to adverse treatment)

Our company values diversity. To ensure that we comply with reporting requirements and to learn more about how we can increase diversity in our candidate pool, we invite you to voluntarily provide demographic information in a confidential survey at the end of this application. Providing this information is optional. It will not be accessible or used in the hiring process, and has no effect on your opportunity for employment.

Gender

Race

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races.

Veteran status

Demographic Survey for Colorado Coalition for the Homeless

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.