Employment Application — Three Oaks Behavioral Health & Wellness

Skip to Content

Our Why; Mission & Core Values

What's in a name?

Operations Team

Chapel Hill - Cloister

Downtown Raleigh

Midtown - Raleigh

Psychological Evaluations

Internship Program

Emergency/Crisis Contacts

Video Resources

English

Our Why; Mission & Core Values

What's in a name?

Operations Team

Chapel Hill - Cloister

Downtown Raleigh

Midtown - Raleigh

Psychological Evaluations

Internship Program

Emergency/Crisis Contacts

Video Resources

English

Folder: Meet the Team

Folder: Services

Folder: Programs

Folder: Resources

Our Why; Mission & Core Values

What's in a name?

Operations Team

Chapel Hill - Cloister

Downtown Raleigh

Midtown - Raleigh

Psychological Evaluations

Internship Program

Emergency/Crisis Contacts

Video Resources

Clinical Employment Application

Name *

First Name

Last Name

Preferred Name/Nickname

Pronouns

Email *

Phone Number *

(###)

###

####

How did you learn about Three Oaks? *

If a specific person introduced you to Three Oaks, please indicate their name.

Are you aware of any dual relationship(s) between yourself, current employee(s), and/or client(s) of Three Oaks? If so, please explain.

Please describe & omit any information that would jeopardize a client's confidentiality.

Position Sought *

Desired Start Date *

Desired Pay

$

Preferred Office Location(s) *

Please check all that apply.

Apex (56 Hunter Street)

Chapel Hill (Cloiser Court)

Downtown Raleigh (Washington Street)

East Raleigh (Dresser Court)

Garner (US 70 Hwy W)

Midtown Raleigh (Benson Drive)

North Durham (Guess Road)

North Raleigh (Professional Court)

South Durham (Lyckan Parkway)

West Raleigh (Creedmoor Road)

Virtual (Telehealth Only)

EDUCATION

College (Graduate)

Please include the name of your graduate program/university, degree, and year graduated (or anticipated graduation date).

College (Undergraduate)

Please include the name of your undergrad program/university, degree, and year graduated.

High School

Please include the name & location of your high school and year graduated.

PROFESSIONAL EXPERIENCE

Are you currently employed? If so, where? *

Licensure Status *

Awaiting license (recent graduate)

Provisionally licensed

Fully licensed

Licensure Type & Number(s), Issue Date(s), Expiration Date(s), NPI, CAQH (if available) *

Date of Full Licensure *

Please indicate the month & year Full Licensure was reached. (If you are Provisionally Licensed, please list the ESTIMATED month & year of achieving Full Licensure.)

Specialties, Preferred Modalities, Desired Client Population (age range, presenting symptoms/concerns, etc.) *

In as much detail as possible, please describe your ideal clinical population.

Continuity of Client Care *

Do you anticipate any of your current clients choosing to continue services with you if you are hired for this position? Your response will help our Referrals team support your clients in a smooth transition to our practice.

If you answered YES above:

Please provide any relevant context to help us understand your current client relationships and the likelihood of transition.

Working Schedule *

When do you work best? Please describe your availability & calendar preferences (days, times) when considering direct client work.

Are you currently credentialed with any of the following insurance companies? *

Please check all that apply.

BCBS

Aetna

Evernorth (formerly Cigna)

I have never been credentialed.

I am not currently credentialed but have been previously.

Professional References

Please list your references' names & emails below.

Professional Profile

If you'd like to share your LinkedIn page, please paste the URL here.

http://

Is there anything else you'd like to share?

Thank you for your submission. We look forward to getting in touch with you soon!

Three Oaks Behavioral Health & Wellness

Instagram
Facebook

Mailing Address

1011 Dresser Court
Raleigh, NC 27609

Contact Us

General Mailbox
(919) 514-3566

Fax
Medical Records Requests: (919) 516-0057
Client Referrals: (919) 342-6511

*No mobile information will be shared with third parties or affiliates for promotional purposes. Opt-in requests include text messaging originator data and consent. Your information will never be shared for marketing.