Seven Starling - Licensed Telehealth Therapist

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Full name✱
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Email✱
Phone ✱
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Current company

Links

LinkedIn URL✱
Twitter URL
GitHub URL
Portfolio URL
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License(s)

Please include a copy of your license(s). Please feel free to remove any dates or other information that may identify your age on your license.
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State(s) Licensures

What state(s) are you licensed in? (Please include and label any inactive, lapsed or pending states.)✱

Sponsorship/Visa

Do you now, or will you in the future require sponsorship for employment visa status (i.e. H-1B visa status)?✱
- Yes
- No
Are you authorized to work in the United States?✱
- Yes
- No

Referral

Please let us know where you saw the posting for this role. If someone referred you please include their name here.✱

Therapist - Direct Care Questions

Why are you passionate about perinatal mental health?✱
How many years experience do you have in perinatal mental health?✱
How many years experience do you have providing direct care in a therapeutic setting?✱

Residency - AL

Do you reside in Alabama?✱
- Yes
- No

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

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Licensed Telehealth Therapist - Alabama