Who We Are
Counseling
- Individuals
- Couples
- Families
- Groups
Careers
Resources
Find My Therapist

Who We Are
Counseling
- Individuals
- Couples
- Families
- Groups
Careers
Resources
Find My Therapist

Who We Are
Counseling
- Individuals
- Couples
- Families
- Groups
Careers
Resources
Find My Therapist

Who We Are
Counseling
- Individuals
- Couples
- Families
- Groups
Careers
Resources
Find My Therapist

Client Portal

Who We Are
Counseling
- Individuals
- Couples
- Families
- Groups
Careers
Resources
Find My Therapist

Who We Are
Counseling
- Individuals
- Couples
- Families
- Groups
Careers
Resources
Find My Therapist

Client Portal

Application for Employment

Name(Required)

First Name Last Name

License(s) Pursuing(Required)

LPC

LMFT

LCSW

N/A

License(s) Obtained(Required)

LPC

LMFT

LCSW

N/A

Registered Supervisor(Required)

Yes

Address(Required)

Address Line 1 City State Zip Code

Email(Required)

Phone(Required)

Have you been in personal counseling?(Required)

Yes

If yes, how many sessions?(Required)

Do you have a preferred religious affiliation?

Are you a U.S. citizen?(Required)

Yes

Have you ever been convicted of a felony?(Required)

Yes

If yes, please explain.(Required)

Professional Goals(Required)

Hidden

If applying for Practicum, Internship or Residency, please select up to two supervisors you would like:(Required)

Marianne G. Shirilla, MAMFC, LMFT, LPC-S

Dr. Debra L. Rezendes, LMFT

Not applicable

Hidden

CC Email Checkbox(Required)

– Fill Out Other Fields –

Education

Bachelor's Education(Required)

Graduate Education(Required)

Graduate Education Accrediting Body(Required)

CACREP

COAMFTE

NASW

None

References

Reference 1(Required)

First Name Last Name

Title(Required)

Email(Required)

Phone(Required)

Reference 2(Required)

First Name Last Name

Title(Required)

Email(Required)

Phone(Required)

Reference 3(Required)

First Name Last Name

Title(Required)

Email(Required)

Phone(Required)

Attachments

Please attach your cover letter, resume, and transcript(s). You may elect to provide additional documentation you deem relevant for consideration, however, this is optional.

Cover Letter(Required)

Max. file size: 128 MB.

Resume(Required)

Max. file size: 128 MB.

Transcript(s)(Required)

Max. file size: 128 MB.

Other

Max. file size: 128 MB.

Signature Disclaimer

I certify that my answers are true and complete to the best of my knowledge.(Required)

If this submission leads to my employment, I understand that any false or misleading information provided in my application or interview may result in termination of employment.(Required)

Electronic Signature(Required)

First Name Last Name

By electronically signing above, I certify my identity as the applicant reflected on this form. I further certify my intent to release this application and all information herein, including all attached documentation, to Synergy Counseling for employment consideration.

Date(Required)

MM slash DD slash YYYY

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

The Synergy Counseling office

The Synergy Counseling office is centrally located in Northern Virginia in the heart of Fairfax City. Our convenient location serves the communities of DC, Maryland and Virginia. Free parking is available at all times.

571-530-9538

suzy@synergycounselingllc.com

10379-B Democracy Lane
Fairfax, VA 22030

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Start your career at Synergy

When you embark on your journey with Synergy Counseling, you are not just taking on a role; you are stepping into a community and culture that values people, integrity, growth and global thinking in every aspect of our work. We will empower you to make a real difference in the lives of those we serve. Join our Team!

Start your journey with us