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.
Your Company's ABN
YesNo
Your Business Logo (if you have one)

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Your Postal Address?*

Street Address

Street Address Line 2

CityState / Province

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

YesNoOther
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?
AboriginalTorres Strait IslanderBoth Aboriginal and 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*

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Insurance Certificate*

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

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Working with Children / Blue Card Clearance*

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Signed Independent contractors Form*

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Print name
Date

MonthDayYear
Date
Signed

Clear

Availability & Service Delivery
Approximate weekly capacity
Yarning CirclesWorkplace trainingOnsite sessionsConflict Resolution ProcessesCrisis Support

Expression of InterestBilaEmpower Clinician Panel