Career – Psychotherapy

Clinician / Provider Application & Pre-Confirmation Verification

For 123Psych network opportunities and 123Psych.net provider onboarding. Complete all relevant fields. Required 123Psych application fields are marked *. Provider approval is conditional on the verification checklist at the end.

1 | Personal information

First name

Last name

Phone (with country code)

LinkedIn URL

Practice website / professional profile

Country currently practising in

State / region

2 | Professional role and qualifications

Professional category

Additional professional category (if applicable)

Highest qualification

Qualification title

Awarding institution

Graduation year

Masters degree in counselling or clinical psychology?

Professional registration / accreditation status

Registration / accreditation body

Registration / membership number

Registration expiry date

Coaching certifications (ICF etc.; enter None if none)

3 | Clinical experience and service eligibility

Years of professional experience

Clinical specialisations / scope of practice

Languages for clinical services

Delivery preference

Telehealth eligibility / authority to practise remotely

Jurisdictions where permitted to treat clients

Telehealth training / platform experience

4 | Application details

Position of interest

Expected salary / contract rate and currency

Earliest available start date

Notice period

Weekly availability / timezone

123Psych referrer (enter None if none)

Resume / CV PDF or Word, up to 10 MB.

Cover letter (optional)PDF or Word, up to 10 MB.

5 | Mandatory screening information

Provide evidence to the authorised onboarding team through a secure channel. Do not insert identity-document numbers or sensitive screening reports into this form.

Qualification certificates / transcripts available

Current registration evidence available

Professional indemnity insurance certificate available

Telehealth eligibility evidence available

Working with Children Check (WWC) status

National Police Check status

Worker Screening Check status

Insurance provider / policy expiry (if applicable)

WWC jurisdiction / expiry (if applicable)

Police Check issue date (if applicable)

Worker Screening jurisdiction / expiry (if applicable)

7 | Declaration

I declare that the information supplied is accurate, that I will notify 123Psych.net of changes to registration, insurance, or eligibility, and that I understand no provider engagement is confirmed until mandatory checks are completed.

I agree with the declaration above

Applicant full name

Applicant signature (typed)

Date

Privacy Notice – Job Applicants

123Psych | Recruitment and Employment Applications

Privacy Notice

123Psych respects your privacy and is committed to protecting personal information provided when you apply for employment or professional opportunities with our organisation. We collect and use information to assess applications, communicate with applicants and manage recruitment.

Collection of Personal Information

We may collect your name and contact details; resume, cover letter and employment history; qualifications, certifications and professional memberships; AHPRA registration details where applicable; work rights in Australia; availability and preferred working arrangements; referee details; and other information reasonably relevant to the role.

We may also collect information from interviews, references and recruitment assessments. Sensitive information will be collected and handled in accordance with applicable law, including consent requirements where relevant.

How We Use Your Information

We use applicant information to assess qualifications, skills and suitability; verify professional registration and work eligibility; conduct interviews and checks; communicate outcomes; prepare employment or contractor agreements; and meet legal, regulatory and professional obligations.

We will not use your information for unrelated purposes unless you consent or the use is otherwise permitted by law.

Confidentiality and Disclosure

Applicant information is treated confidentially and accessed only by authorised 123Psych personnel and relevant recruitment service providers. Information may be disclosed with your consent, for recruitment checks where permitted by law, where required or authorised by law, or to address a serious threat to health or safety where legally permitted.

Where appropriate, we will seek your consent before contacting referees or conducting background checks.

Storage, Security and Retention

123Psych takes reasonable steps to protect personal information from misuse, interference, loss and unauthorised access, modification or disclosure. Information may be held in appropriately secured electronic or other records.

We retain applicant information only as long as reasonably necessary for recruitment and related lawful purposes, after which it will be securely destroyed or de-identified where appropriate.

Unsuccessful Applications

If your application is unsuccessful, we may retain relevant information for a reasonable period for recruitment administration, legal compliance or future opportunities, where permitted by law. You can ask not to be considered for future roles.

Access, Correction and Privacy Concerns

You may request access to, or correction of, personal information we hold about you. You may also raise a concern or complaint about our handling of your information. Requests will be considered in accordance with applicable privacy laws.

Acknowledgement

By submitting an application, you acknowledge that you have read this notice and understand how 123Psych handles personal information for recruitment purposes. Where separate consent is legally required, we will seek it.

Contact Us

123Psych – Recruitment Team
Email: application@123Psych.net

I acknowledge that I have read and understood the 123Psych Privacy Notice and understand that my personal information will be collected, used and stored for recruitment and employment-related purposes in accordance with applicable Australian privacy laws.