Job Application Form

Job Application Form
Application Date

MonthDayYear
Date
Application Method

LCCS WebsiteLinkedInManualOtherOther
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Location

Minnesota VirtualMinnesota OfficeMichigan VirtualMichigan Office
Position of Interest*

Psychotherapist, ContractMental Health PractitionerInternshipOther
Degree Level/ Experience*

Masters DegreeBachelors DegreeCareer ChangerExperiencedInexperienced
Credentials*

LPCCLICSWLMSWLADCLSWMSWLGSWOther
Cover Letter
Please upload your resume and any other documents you would like us to review.*

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