Map and Directions
Phoenix/Anthem Office
Scottsdale Office
Call: 623-680-3486
Text: 623-688-5115
Make an Appointment
Home
Individuals
Anxiety Counseling
Depression Counseling
Trauma & PTSD Treatment
Grief & Loss Counseling
ADHD Bootcamp
Women’s Counseling
Men’s Counseling
Video & Telehealth Therapy for Individuals
Couples
Relationship / Marriage Counseling for Couples
Couples Counseling for One
Premarital Counseling
Affair and Infidelity Counseling
Discernment Counseling for Couples
Video & Telehealth Therapy for Couples
Families
Child Counseling
Teen Counseling
ADHD Bootcamp
Video & Telehealth Therapy for Families, Children & Teens
About
Scottsdale Counseling Center
North Phoenix & Anthem Counseling
Video & Online Therapy Arizona
Christian Counseling
Emotionally Focused Therapy Scottsdale Phoenix Online in AZ
Employment with Crossroads Counseling
Q&A and Insurance
Find A Therapist
Groups
& Events
Marriage and Couples Therapy Intensives
Beyond Trauma: A Program for Transformation and Authentic Healing
ADHD Bootcamp
Teen Girls Therapy Group
The Connected Woman
The Connected Man
Hold Me Tight Couple’s Seminar
Calendar of Events
Contact
Blog
Quizzes
Application Form
Home
Application Form
Application Information
Name
First
M. I.
Last
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Email
Date Available to Work
Position Applied For
Are you a citizen of the United States
Yes
No
If no are you authorized to work in the United States
Yes
No
Have you ever been convicted of a felony
Yes
No
If yes, please explain
Education
High School
Did you graduate?
Yes
No
College
From
To
Did you graduate?
Yes
No
Degree
College
From
To
Did you graduate?
Yes
No
Degree
College
From
To
Did you graduate?
Yes
No
Degree
References
Please list at least two professional references.
Full Name
Relationship
Company
Phone
Full Name
Relationship
Company
Phone
Full Name
Relationship
Company
Phone
Job History
Company
Phone
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for reference?
Yes
No
Company
Phone
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for reference?
Yes
No
Company
Phone
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for reference?
Yes
No
Disclaimer and Signature
Consent
*
I agree
*
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also understand that conditional to employment is passing a background check through Goodhire.com. By Signing this form I give my consent to allow Crossroads Counseling to send me information to complete a background check.
Name
Date
Resume or CV
Please upload your resume or curriculum vitae here:
Accepted file types: doc, docx, pdf, Max. file size: 5 MB.
Email
This field is for validation purposes and should be left unchanged.
Menu