Healthy Healing Counseling, Inc.

166 Old Waterville Road, Suite #1
Oakland, Maine 04963
(207) 465-9001

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Have you ever been convicted of a felony?

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If yes, explain

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May we contact your previous supervisor for a reference?

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Disclaimer and Signature

By submitting this form I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I understand that if I am interviewed, I will be required to sign and date this application.

Signature: ______________________________________________

Date: ________________________

Please verify you are human(*)

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HEALTHY HEALING

COUNSELING, INC.

Employment Application

Healthy Healing Counseling, Inc.

Applicant Information

Education

References

Previous Employment

Military Service

Disclaimer and Signature

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Healthy Healing Counseling, Inc.