Substance Use and Gambling Therapist - Application form 2024/5

Application form - Therapist

Closing date for applications - 12 noon, 30th December 2024
It is important all elements of this form are completed. Incomplete forms will not be processed. It is not sufficient to submit only a CV.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

City/ParishState / Province

Postal / Zip Code
Email
example@example.com

Work address

Street Address

Street Address Line 2

City/ParishState / Province

Postal / Zip Code
Phone number:
May we contact you by:

TelephoneEmailAt work
Period of notice in current role:
Are you in good health?

YesNo
If you answered no to the above please state the reason(s)
How many days sickness absence have you had in the last 2 years?
Do you hold a valid driving licence?

YesNo
Please state your present/most recent annual salary and details of any additional benefits/allowances. We may verify this.

Education & Qualifications
Please list the university/college, subject, qualification/grade, and dates attended From mm/yyyy to mm/yyyy.
Relevant in-house training or CPD in the last 12-months.
Course title, provider, dates to and from dd/mm/yy
Please state any relevant professionals memberships/registrations including member number(s):

Please provide an outline of your employment history starting with the most recent, and including employer's name, address, position held, a brief description of duties, and duration of employment (From/To mm/yy) including your reason for leaving.
Please provide the names and addresses of two referees (one of whom should be you manager/clinical supervisor of current employment).
Can we contact your current employer prior to interview?

YesNo
Please tell us more about why you are interested in the position, your expectations of the role; how your skills, past achievements, qualifications, experience and personal qualities make you suitable for this role and which model of therapy you practice.
What are your views on treatment and recovery?
Have you ever used or traded in illegal drugs? Please provide a brief detail.
Have you ever, or are you currently subject to any investigation or enquiry? Please provide details.
Do you hold a valid right to work document?

YesNo
This position requires an Enhanced Disclosure and Barring certificate which you are responsible for providing. No offer of employment will be made without an enhanced DBS.

If you are registered on the online update service please provide your DBS certificate number.
DBS Certificate number:
Should be Empty:

Application form - Therapist