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Tell us about yourself and attach your resume. It takes about five minutes.

Employment application

Fields marked with an asterisk are required. If you would rather apply by email, send your resume to prolificintakes757@gmail.com.

Position

Position applying for *

Preferred location *

Employment type sought

Earliest start date

Shifts you can work Several of our roles include overnight and weekend coverage.

Your details

First name *

Last name *

Email *

Phone *

City and state

Qualifications

Licence, certification or registration e.g. QMHP-A, LPC, LCSW, RN, Peer Recovery Specialist

Licence or registration number

Highest level of education

Years of relevant experience

I have lived experience of mental health or substance use recovery and am comfortable sharing that. Optional, and a genuine qualification for our peer roles.

Do you have a valid driver’s licence and reliable transportation? Community-based roles require travel between sites.

Are you authorised to work in the United States? *

Resume and cover letter

Resume * PDF, DOC or DOCX, up to 10 MB.

Cover letter Optional. PDF, DOC or DOCX.

Why do you want to work here? A few sentences is plenty.

Work history

Start with your present or most recent employment and work back. Include paid and unpaid positions. Attaching a résumé is welcome, but please still complete these.

Position #1 — most recent

Job title

Company name

Start date

End date Leave blank if current

Supervisor’s name

Phone number

City

State

ZIP

Duties

Reason for leaving

Starting salary

Ending salary

May we contact this employer?

Position #2

Job title

Company name

Start date

End date Leave blank if current

Supervisor’s name

Phone number

City

State

ZIP

Duties

Reason for leaving

Starting salary

Ending salary

Position #3

Job title

Company name

Start date

End date Leave blank if current

Supervisor’s name

Phone number

City

State

ZIP

Duties

Reason for leaving

Starting salary

Ending salary

Position #4

Job title

Company name

Start date

End date Leave blank if current

Supervisor’s name

Phone number

City

State

ZIP

Duties

Reason for leaving

Starting salary

Ending salary

References

Professional references Name, relationship, and phone or email for two or three references.

Certification

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The Employer may contact any listed references on this application. *

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other category of employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, and with or without notice to the other party. *

I understand that employment is contingent on a criminal background check, a Virginia child and adult protective services registry search, and a drug screen. *

Type your full name as an electronic signature * Typing your name here has the same effect as signing the paper application.

Prolific Counseling Group is an equal opportunity employer.

This is a design preview. The form validates correctly but is not connected to anything yet — no file was uploaded and nothing was sent. Wiring up resume storage and an email notification is the next build step.