Registration Form

Candidate Registration Form

Submit this form to register your spot at the Oregon Mental Health Professionals Recruiting Event!
Friday, September 16th from 4-8 pm at TaborSpace in SE Portland. You must register below to participate. It's going to be a great night! Participants will meet a collection of local Group Practices who are hiring for clinical mental health positions. You will have the chance to network, enjoy light refreshments, and get professional headshots taken!

We offer staggered start-times for you to arrive, at 4pm, 5pm, 6pm, and 7pm. Please select the time that works best for you!

Professional headshots are available for a discounted rate by the talented Abigayle Tarsches Photography. Photos are available at $50 for 3 edited images of your choice, which you will receive as digital attachments. Follow these steps to set up your session!
1. Book and pay for your session directly with the photographer HERE.
2. We recommend you reserve your session time now. Priority will be given to those who have signed up. On-site participation will be accommodated as able.
Submit your resume and a brief personal statement about yourself. This will be distributed to all the group practices on your behalf!

COVID Precautions and Verification of Vaccination Status
We want to create a safe environment for networking and connection for all who attend this event. Healthcare providers and staff in the state of Oregon are required to be fully vaccinated by the Oregon Health Authority and we are hiring accordingly. As an attendee of the networking event, you will be required to show proof of full vaccination at the door upon your arrival. In addition, masks will be required indoors unless eating and drinking. A negative PCR test (sent to a lab, not a rapid test) within 48 hours can be presented if health conditions compromise your ability to be vaccinated at this time.

This event will serve light refreshments and non-alcoholic beverages, in support of colleagues in recovery. Inclusive bathrooms are available on-site. This facility is accessible for bodies of all abilities.
Candidate Information

Please fill out completely.
Preferred Name*

First NameLast Name
Pronouns*
Best Contact Email*
example@example.com
Best Contact Phone Number*
Birthdate (mm/dd/yyyy)*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
We offer staggered arrival times. Please select your expected arrival time.*
How did you hear about this event?
Please be specific - names, organizations, groups, or platforms that gave you information.
Professional headshots are available for a discounted rate by the talented Abigayle Tarsches Photography. Photos are available at $50 for 3 edited images of your choice, which you will receive as digital attachments. Follow these steps to set up your session!
1. Book and pay for your session directly with the photographer HERE.
2. We recommend you reserve your session time now. Priority will be given to those who have signed up. On-site participation will be accommodated as able.
Professional Information
Profile page or professional website.
List as many as you have available
Select your professional status, as it relates to licensure.*
List your license number.
What state(s) are you licensed in or working towards licensure?*
For Associates: How far along are you in obtaining your licensing hours?
Please list how many hours you have completed out of the total you need and include an estimated time for completion.
Are you in need of supervision (either included with your position or from an outside source)?*
Include your resume. *Please name your document in the following way: "Last name, First name Resume 2022"*

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Please share a brief personal statement about yourself and what you are looking for in your next professional chapter of your career. *
Matching Information

This information helps determine good fits between candidates & Group Practices.
What working conditions are you interested in?*

Only TelehealthOnly In-personHybrid options (mix of telehealth & in-person)No preference
What area of Oregon are you interested in working? Select all that apply.

North PortlandNE PDXSE PDXSW PDXNW PDXTualatinHillsboroBeavertonTigardWest LinnEugeneAstoriaAlbanySalemOther
Describe the type of group practice, environment, organizational culture and team you are looking to join. *
Describe the annual income you are looking to make, along with the amount of hours per week you are able to dedicate to your position.*
Describe the client population you would like to work with, including ages, diagnoses, and other demographics. *
Include a list of the treatment approaches, trainings, certifications, or skill sets you use in your clinical work.*
Accessibility
What accommodations would be helpful to you during the event?
Photo Release
I blanks* , grant permission and give my consent to the Group Practices of this Networking Recruiting Event to take and use photographs or electronic media images from this event that may contain my image for presentation under any legal use.
Proof of Vaccination

As organizers and participants, we are creating a safe environment for networking and connection for all who attend this event. Healthcare providers and staff in the state of Oregon are required to be fully vaccinated by the Oregon Health Authority and we are hiring accordingly. As an attendee of the networking event, you will be required to show proof of full vaccination at the door upon your arrival. In addition, masks will be required indoors unless eating and drinking. A negative PCR test (sent to a lab, not a rapid test) within 48 hours can be presented if health conditions compromise your ability to be vaccinated at this time.
Please include your acknowledgement of this information and your consent to participate.*

Great! I will be able to provide proof of my vaccination at arrival. I understand this is a requirement to participation.
Thank you!
Your responses are incredibly valuable! As a collective of local group practices, we are invested in creating a collabortive environment that creates good matches between candidates and workplaces. The exchange of information with the opportunity to meet each of you sets up more successful interviews and offer letters! This is an exciting time in the mental health profession and we can't wait to work together for the care of our community.

If you have additional questions or feedback about the event, please contact Ellie Buhr at ellie@ccstpdx.com.
Should be Empty:

Candidate Registration Form

Candidate Information

Professional Information

Matching Information

Accessibility

Photo Release

Proof of Vaccination

Thank you!