MINIMUM QUALIFICATIONS CHECKLIST
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In addition to answering the questions below regarding your qualifications, please submit a resume and cover letter with your Employment Application. Your cover letter should address why you are interested in working at Unity Care NW and describe your experience in a position of this type.
|QUALIFICATIONS |Yes |No |
|Are you certified as a Washington State Chemical Dependency Professional (CDP)? | | |
|Are you an independently Licensed Clinical Social Worker, Licensed Mental Health Counselor, Licensed Marriage & | | |
|Family Therapist, or Psychologist in Washington State (preferred, but not required)? Please indicate type of | | |
|license: | | |
|If you are not currently independently licensed in WA State, what type of license do you have (for example, | | |
|Associate or Agency Affiliated) &/or are you eligible to be licensed in WA State (for example, if you are an | | |
|out-of-state candidate)? Please explain here: | | |
|Are you eligible to provide clinical supervision to CDP trainees per Washington Administrative Code (WAC) | | |
|246-811-049. | | |
|Do you have any action on a state license or have any malpractice claims been made against you? If yes, please | | |
|explain: | | |
|Do you have a current CPR/Basic Life Support (BLS) certification? If yes, please indicate expiration date: | | |
|The Centers for Disease Control and Prevention strongly recommends the following vaccines for healthcare | | |
|workers: Influenza, Measles, Mumps and Rubella (MMR), Varicella (Chickenpox), Tdap (Tetanus, Diphtheria, | | |
|Pertussis) and Tuberculosis screening. As a Unity Care NW employee, would you agree to follow these CDC | | |
|recommendations? | | |
I hereby certify that all statements made above are true and correct.
Signature Date
Print Name
-----------------------
Chemical Dependency Professional
QUALIFICATIONS CHECKLIST
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