Volunteer Counsellor Application
1. Personal Details
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
2. Information about your course
Are you currently a student on an appropriatley accredited counselling course?
*
Yes
No
Name of course
*
Name of institution/training provider
*
Is your course registered with a governing body?
*
Yes
No
Name of governing body?
Has your course signed you off for placement?
*
If no, when do you expect to be able to start placement?
If already on placement, how many client hours have you completed?
3. Qualifications
Educational Qualifications
*
Subjects Studied
Qualifications Gained
Place of study
Date completed
1
2
3
4
5
6
7
8
9
10
Additional Qualifications/Training
Courses Attended
Qualifications Gained
Place of study
Date completed
1
2
3
4
5
4. Previous Employment
Please include details of all work experience, paid or voluntary, beginning with the most recent and working backwards.
Name and address of organisation
Position Held
Dates employed
1
Job Duties and Responsibilites:
Reason for leaving:
Name and address of organisation
Position Held
Dates employed
2
Job Duties and Responsibilites:
Reason for leaving:
Name and address of organisation
Position Held
Dates employed
3
Job Duties and Responsibilites:
Reason for leaving:
5. Interests and Hobbies
Please give details of pastimes, sports etc, including any offices or positions of responsibility.
*
6. Additional Details
Do you own a car?
*
Please Select
Yes
No
Have you a current driving licence?
*
Please Select
Provisional
Full
No
Have you any current endorsements?
*
Please Select
Yes
No
If yes, give details:
Are there any restrictions on you taking up employment in the UK?
*
Please Select
Yes
No
If yes, give details:
7. Language
Occasionally we have clients who are not native English speakers and would benefit from having counselling in their own language.
If you speak any additional languages please list them here. There is no requirement however to share this.
Would you be happy to work with a client who spoke any of the above stated languages.
Yes
No
8. References
Please tick here if you wish to be consulted before your referees are contacted
Reference 1: Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Occupation/Relationship:
*
Reference 2: Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Occupation/Relationship:
9. Further Information
With reference to the service specification and person specification, please give us any further information which you feel will support your application, including your reasons for applying and how your skills and experience will contribute to the aims of the post (500 words).
*
10. Declaration
I understand that it is Trauma Healing Together’s policy to employ the best qualified person regardless of race, sex, marital status or disability. I authorise Trauma Healing Together to obtain references to support this application. I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient for rejection or, if employed, dismissal.
Signature
*
Submit
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