Headlight - Licensed Professional Counselor (LPC)

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Full name✱
Pronouns
- Use name only
- Custom
Email✱
Phone ✱
Current location ✱
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Preferred Name

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Therapy Application Questions

Years of Experience as a fully licensed therapist?✱
Please review the office location in the job title. Do you have an active license (LPC, LMFT, LCSW, Psychologist) in the state of this office?✱
Which of the following licenses do you hold?✱
What modalities do you utilize?✱
- CBT
- DBT
- EMDR
- Art Therapy
- Play Therapy
- Gestalt therapy
- Solutions-focused
- Acceptance and Commitment
- Person-centered
- Psychodynamic Therapy
- Motivational interviewing
- Mindfulness
- Other
What diagnosis do you typically see in your practice?✱
- Neurodevelopmental Disorders
- Schizophrenia spectrum and other psychotic disorders
- Bipolar and related disorders
- Depressive disorders
- Anxiety disorders
- Obsessive-compulsive and related disorders
- Trauma- and stressor-related disorders
- Dissociative disorders
- Somatic symptom and related disorders
- Feeding and eating disorders
- Sleep–wake disorders
- Sexual dysfunctions
- Gender dysphoria
- Disruptive, impulse-control, and conduct disorders
- Substance-related and addictive disorders
- Neurocognitive disorders
- Personality disorders
What settings have you worked in?✱
- Outpatient
- Inpatient
- Residential Treatment
- Telehealth
- Community Mental Health
- Private Practice
- Correctional
- Non-Profit
- Rehabilitation
- Other
Which of the following populations/services do you typically provide?✱
- Children
- Adolescents
- Adults
- Geriatric
- Group
- Couples
- Individual
- Family
- Crisis Intervention
What state do you reside in?✱
What state(s) are you fully licensed in as a therapist?✱
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
Are you open to getting additional state licenses if hired at Headlight?✱
- Yes
- No
Cover Letter/Additional Documents (optional)
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Licensure (optional)
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Part time

Are you looking for Full Time or Part Time employment?✱
- I am looking for part time schedule - up to 24 hours per week
- I am looking for Full time
- I am open to both FT and PT

Bilingual

Please select any languages you speak, read, and write fluently✱

Additional information

Demographic Survey for Headlight

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.

I identify my ethnicity as
Select all that apply
- White / Caucasian
- Hispanic, Latino, or Spanish origin
- Black or African American
- Asian
- Native Hawaiian or other Pacific Islander
- Indigenous Peoples, First Nations, Native American, or Alaska Native
- Middle Eastern or North African
- Some other race, ethnicity, or origin
Are you Hispanic/Latino?
- Yes
- No
- Decline to Self Identify
What gender do you identify as?
- Female
- Male
- Non-binary
- Genderqueer
- Genderfulid
- Agender
- Cisgender
- Transgender
- Gender-neutral
- Gender nonbinary
- Intergender
- Polygender
- Genderflux
- Androgynous
Veteran Status
- I am not a protected veteran
- I identify as one or more of the classifications of a protected veteran
- I do not wish to answer
Disability Status
- Yes, I have a disability, or have had one in the past
- No, I do not have a disability and have not had one in the past
- I do not want to answer

By applying for this position, your data will be processed as per Headlight's .