First Name
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Last Name
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Phone
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Email
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Preferred Pronouns
Where are you currently located?
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Please provide your city and province only.
How did you hear about our practice?
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Professional Qualifications
Which position or professional role interests you?
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Psychologist
Psychological Associate
Doctoral Associate (Ph.D candidate in a clinical psychology who has completed several clinical placements)
Registered Psychotherapist - Autonomous Practice
Registered Psychotherapist - Supervised Practice
Registered Psychotherapist (Qualifying)
Social Worker
Other
Please provide your regulatory college and registration category, if applicable.
Are you currently authorized to practice in Ontario?
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Are you legally entitled to work in Canada?
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Please summarize your education, clinical training, and relevant professional experience.
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Please do not include identifying information about clients.
Approximately how many years of post-graduate clinical experience do you have?
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Currently completing training
Less than 1 year
1–2 years
3–5 years
6–10 years
More than 10 years
Which clients populations are you trained and interested in working with?
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Children
Adolescents
Adults
Older Adults
Couples Families
Neurodivergent Clients
2SLGBTQIA+ clients
Racialized or culturally diverse communities
Other
Which services are you qualified and interested in providing?
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Individual psychotherapy
Couples therapy
Family therapy
Group therapy
Psychological assessment
Psychoeducational assessment
Autism assessment
ADHD assessment
Supervision
Workshops or community education
Other
Please describe your main areas of clinical interest and competence
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Which therapeutic approaches meaningfully inform your work?
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Please briefly describe how you integrate these approaches into your clinical work rather than listing modalities alone.
Please list any formal training you have completed in specific therapeutic approaches or modalities.
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You may also include relevant certifications or training currently in progress.
Please indicate your current training, experience, or interest in developing competence in the following areas of practice:
Anxiety and mood disorders
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Eating disorders and disordered eating
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Body image concerns
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Perinatal and reproductive mental health
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Trauma and PTSD
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ADHD and neurodivergence
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Insomnia and sleep concerns
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Burnout and work-related concerns
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Grief and loss
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Women’s mental health
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Other areas relevant to our practice
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Please upload your résumé or curriculum vitae.
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PDF preferred
Availability and Practice Preferences
When would you ideally be available to begin ?
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Approximately how many clinical hours or client appointments would you like to offer each week ?
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What is your general availability ?
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Weekday mornings
Weekday afternoons
Weekday evenings
Saturdays
Sundays
Which service format are you interested in providing ?
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In-Person
Virtual
Values and Practice Community
What attracted you specifically to Uprise ?
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We are especially interested in what resonates with you about our approach, values, services, or community.
After reviewing our website and practice values, which two values resonate most strongly with you, and why?
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What does being part of a professional practice community mean to you?
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What would you hope to receive from the practice, and what would you hope to contribute in return?
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Which statement most closely reflects what you are seeking at this stage?
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Confirmation
Please confirm the following:
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The information I have provided is accurate to the best of my knowledge.
I understand that submitting this form does not guarantee an interview or position.
I consent to Uprise contacting me about this expression of interest.
I understand that my professional registration and references may be verified later in the recruitment process.
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