Counsellor Volunteer Placement Application Form

Counsellor Volunteer Placement Application Form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

POSTCODE
Contact Detail
Email*
Mobile Number*
Work Number
DBS Check: Students are required to run their own DBS check (you will be reimbursed if your application is successful)
Do you have a current DBS?*

YesNo
Issue Date of DBS

MonthDayYear
Date
DBS Certificate Number
Please note all volunteers are required to undergo criminal record checks as provided by the Disclosure and Barring Service. This record check will include details of cautions, reprimands or final warnings, as well as convictions. A criminal record will not affect your chances of volunteering unless we decide it makes you unsuitable. The nature of the offence, how long ago and what age you were when it was committed, patterns of offending and any other relevant factors will be considered Any information will be kept in strict confidence and will be stored securely. If these checks reveal evidence we believe makes you unsuitable to volunteer with us either at the start of the process or any time later, we will not be able to start/continue the volunteering relationship. By signing this application, you are giving your consent to these checks being carried out at any time during your volunteering with The Angels Foundation UK Counselling and Therapy.
Have you been convicted of a criminal offence?*

YesNo
If answered YES, please give details of date(s) of offence(s) and sentence(s) passed
Counselling Qualifications or Any Relevant Training

Please provide details of any courses you are attending or any training you have attended related to this role.
College/Training Provider*
Course Title
Date Started

MonthDayYear
Date
Date Completed
Areas Covered*
Any practical counselling experience or helping support you have/or are currently providing, please give details below. (If none, put n/a or 0)
Face to Face*
Number of Hours
Personal therapy*
Number of Hours
Telephone Support*
Number of Hours
Group*
Number of Hours
About You
Why do you want to do this role, and why now?*
What skills do you have that you feel will be helpful to this role?*
What life experience(s), if any, may influence on your role as a counsellor?*
Employment Record

Please give details of you most recent employment
Name of Employer*
Job Description
Date Started

MonthDayYear
Date
Date Ended
Placement Availability and Commitment

(You will also be responsible for agreeing a mutually available time and day for sessions with your client/s)
Monday - Available Times (inc Evenings)*
Tuesday - Available Times (inc Evenings)*
Wednesday - Available Times (inc Evenings)*
Thursday - Available Times (inc Evenings)*
Friday - Available Times (inc Evenings)*
Referees

Please provide the names of TWO referees if possible
Name of Referee 1*
Relationship *
Address*
Contact Telephone Number*
Name of Referee 2
Relationship
Address
Contact Telephone Number
Declaration
I certify that the information given above is a true and accurate record:
Name*
Full Name Required
Date*

MonthDayYear
Date
Should be Empty:

Counsellor Volunteer Placement Application Form

Contact Detail

Counselling Qualifications or Any Relevant Training

About You

Employment Record

Placement Availability and Commitment

Referees

Declaration