Psychologist

First name*

Last name*

Email address*

Location *

Phone number*

Resume*

What attracted you to apply to Intent Clinical?

Are you comfortable with a PRN work schedule that is inconsistent and on an as-needed basis?

Part-time psychologists at Intent Clinical are called on an as-needed basis based on client needs. Work expectations are provided before case acceptance.*

How many years of experience do you have as a licensed psychologist?

Please describe your experience conducting assessments.

How did you get into this field?

What type of clientele have you worked with? Do you have any specialties?

Which populations or diagnosis do you feel most competent working with and which ones do you feel least competent working with?

How comfortable are you seeking consultation, supervision or guidance on a case?

What is your approach with clients?

Are you able to support clients in language(s) other than English? If yes, what is your level of proficiency?

How do you manage difficult clients or situations?

Please describe your proficiency with basic computer skills such as email and Microsoft Office or Google suite.

Do you want to tell us anything else about you?

A license is required to perform this role. Do you currently or have you ever held clinical licensure?*

If you answered yes above, please provide your license type, number, and state of issuance. Please clarify if this licensure is active, or if your licensure has ever lapsed or expired.*

What is your desired hourly rate?

What is your highest level of education completed?*

Please identify the names, relationship to you, and email addresses of 2 professional and 2 personal references.*

How did you hear about us?*

Are you a current or former employee of Intent Clinical (or formerly O'Connor Professional Group)?*

If you were referred by an Intent Clinical or OPG employee, who referred you?

I certify that I have read and understand the applicant instructions included with this application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief.


I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment.


I understand that this application form is intended for use in evaluating my qualifications for employment and that this application is not an offer of employment. I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company and that this application is not intended to constitute a contract of continued employment.

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Lie Detector Test for Maryland and Massachusetts Applications:

Under Maryland Law an employer may not require or demand as a condition of employment, prospective employment or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this provision is guilty of a misdemeanor and subject to a fine not exceeding $100.


It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

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By providing my electronic signature, I acknowledge that I have read and self attest to all of the items listed. Please type your name to sign.*

Voluntary Self-Identification of Disability (CC-305)

For more information regarding the Voluntary Self-Identification of Disability, please visit the US Department of Labor.

Gender

Race/Ethnicity

Human Check*