BilaEmpower NEW Contractors Documentation

Expression of InterestBilaEmpower Clinician Panel
BilaEmpower is a First Nations-led organisation delivering culturally integrated Employee Assistance Program services across Australia.

We work alongside sovereign First Nations allied health professionals who are grounded in both clinical excellence and cultural integrity.

This Expression of Interest is an invitation to join a national collective of practitioners supporting social and emotional wellbeing in a way that honours culture, community and lived experience.
Full Name

First NameLast Name
Business Name
Your Company's ABN
Email
example@example.com
Mobile or Phone Number
Format: (000) 000-0000.
Supply Nation Registered / Certified
Your Business Logo (if you have one)

Cancelof
Your Postal Address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who is Your Mob (if known)

Do you identify as Aboriginal and/or Torres Strait Islander?

Other
Please share your Nation, Country and/or community connections
How does culture inform and guide your practice?
What does culturally safe care mean to you in your work?
Aboriginal or Torres Strait Islander
Professional Title
Clinical Psychologist, Psychologist, Clinical Social Worker, Social Worker, Clinical Counsellor, Counsellor, Clinical Psychotherapist, Psychotherapist etc
Date Completed Clinical Qualification

MonthDayYear
You must have 3 years professional experience post qualification.
List of Mental Health Services that you can Provide
For example: Counselling, First Nations Counselling, Coaching, Executive Coaching, DFV, Clinical Supervision
Peak Body Certificate

Cancelof
Insurance Certificate

Minimum of $20m for Professional Indemnity & Public Liability each
Cancelof
National Police Clearance (not less than 12 months old)

Cancelof
Working with Children / Blue Card Clearance

Cancelof
Signed Independent contractors Form

Cancelof
Print name
Date

MonthDayYear
Date
Signed

Availability & Service Delivery
Approximate weekly capacity
In addition to individual client sessions, your willingness to deliver (please check the following):

Reflective Questions
What does healing look like in your practice?
How do you look after your own wellbeing as a practitioner?
What does working within a collective of First Nations clinicians mean to you?
I confirm that the information provided is true and that I am committed to ethical, culturally safe and professional practice.
Should be Empty:

Expression of InterestBilaEmpower Clinician Panel