Speech Therapy Job Interview Questionnaire
Please complete this questionnaire to help us assess your qualifications for the speech therapist position.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Highest Degree Obtained
*
Please Select
Bachelor's in Speech-Language Pathology
Master's in Speech-Language Pathology
Doctorate (PhD/EdD) in Speech-Language Pathology
Other (please specify)
Are you currently licensed/certified to practice speech therapy?
*
Yes
No
How many years of experience do you have as a speech therapist?
*
In which settings have you worked as a speech therapist? (Select all that apply)
*
Schools
Hospitals
Private Practice
Rehabilitation Centers
Telepractice/Online
Other
Please rate your confidence in the following clinical skills:
*
Rows
Assessment
Treatment planning
Articulation therapy
Fluency disorders
AAC (Augmentative & Alternative Communication)
Not confident
1
2
3
4
5
Somewhat confident
6
7
8
9
10
Confident
11
12
13
14
15
Very confident
16
17
18
19
20
Describe how you would approach a new client with an articulation disorder. (Briefly outline your assessment and therapy plan.)
*
Are you available to work full-time, part-time, or on a contract basis?
*
Full-time
Part-time
Contract/Per Diem
Please provide the name and contact information for one professional reference.
*
Submit Application
Should be Empty: