New Counselor Application

"*" indicates required fields

Step 1 of 15

Section 1: Biographical Date

Name*
Select date MM slash DD slash YYYY
Address*
Are you certified with any of the following Biblical Counseling organizations? (check all that apply)*
Do you have any published (check all that apply):

Criminal History

A "yes" answer will not necessarily disqualify you from this position. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered. Any information regarding criminal history will be maintained confidentially.

Please do not list misdemeanor convictions for marijuana-related offenses that are more than two years old and convictions that have been judicially dismissed, expunged or ordered sealed pursuant to law.

**Please note that a national and state background check will be conducted before any formal offer of employment