Psychotherapist (Clinical Support) Application Form

Psychotherapist Job Description
Name:*

First NameLast Name
Other names (If applicable):

Middle namesMothers Maiden Name
Date of birth:*

DayMonthYear
Date
Country of Birth:*
E-mail Address:*
Name@example.co.uk
Mobile number:*
National insurance number:*
Current home address:*

Building number and street name

TownCity

Post code
Updated CV:*

All previous employment must abe listed on your CV, showing clear start and end dates (month and year) and evidence of education and qualifications.
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When are you available to commence work?*

DayMonthYear
Date
Hours of work:*
How were you referred to us?

Job boardSocial mediaOther (please specify below)Employee (please specify below)
Employee details: (If applicable)

First NameLast Name
Other:
Are you related or connected to another employee in the company? (If yes please specify below)*
First Name Last name
Due to the age and needs of the young people in our care, and in line with safeguarding best practice, applicants must be aged 21 or over.

DATA PROTECTION ACT: The information provided within this application may be used for statistical analysis and to obtain references from past and current employees. For applicants joining Brinscall Care, the information provided will be used to administer company operations in connection with their employment. Unsuccessful applications will be destroyed after six months.

Employment history

Due to the nature of this role, we require references for all positions in which you have provided care for children or adults. This includes both paid and voluntary roles, whether full-time or part-time.
References

Please provide the contact details for two referees (none of whom should be close friends or family), who should be able to comment on your suitability for the post for which you are applying. One of these must be your present or last employer. We will request references from all referees named and reserve the right to request additional references. All offers of employment will be subject to the receipt of satisfactory references.

In some instances, you may be required to provide more than 2 so at least 3 years of work history is covered. If you have worked in more care roles other than the ones you have provided, we may seek these references from you too.

NB: It is imperative for speed of process that you make your referees aware that you have named them and that they should complete and return requests as soon as possible.
Reference 1

References will only be sought when applicant has been notified of successful interview and a job offer has been accepted.
Most recent employer (Company name):*
Role:
Start date:*
Currently employed here:*

YesNo
If no, please provide date employment ended:
Name of referee:*

First NameLast Name
Referee and or company email:*
Phone number:*
Company address*

Building number and street name

Street Address Line 2

TownCity

Post code
Please give a brief description of duties and responsibilities:*
Notice period required:*
In weeks*
Reference 2
Name of employer (Company name):
Start date:
Date employment ended:
Name of referee:

First NameLast Name
Referee role:
Company address*

Building number and Street Address

Street Address Line 2

TownCity

Post code
Referee and or company email:
Phone number:
References continued
Do your references above, cover at least 3 years employment?*

YESNO

Psychotherapist (Clinical Support Role)

The Psychotherapist role is designed to complement the work within our homes, supporting the Registered Manager, staff teams, and wider professionals, while ensuring that every young person receives trauma-informed, evidence-based care. Ultimately, the role exists to serve the young person, enhancing their journey of healing, building resilience, and creating opportunities that allow them to thrive.We are looking for a qualified and accredited professional who can bring therapeutic insight, strategic expertise, and clinical guidance into our homes. This role is not only about working directly with children and young people, but also about equipping and supporting staff through reflective practice, supervision, and training.The successful candidate will be confident in embedding the Children’s Homes (England) Regulations and Quality Standards into therapeutic work, and will contribute meaningfully to our Team Around the Child approach, helping to shape safe, nurturing, and resilient environments for young people.
Q1 – Professional Background and Accreditation: Please outline your skills, qualifications, and experience that are relevant to this role. Which professional bodies are you accredited or registered with (e.g. HCPC, BPS, UKCP, BABCP), and what is your area of accreditation/specialism? How does this support your relevance to the role?*
Q2 – Safeguarding and Child-Centred Practice: Safeguarding is at the heart of everything we do. Please describe your approach to safeguarding within a children’s home setting. How do you ensure young people feel safe, listened to, and supported? In addition, how do you see the clinical role enhancing the knowledge, understanding, and practice of the team from a therapeutic perspective?*
Q3 – Upholding and Enhancing Quality Standards: Quality assurance is crucial in our homes. How do you see the clinical role embedding and upholding the Children’s Homes (England) Regulations and Quality Standards? How would you ensure your input compliments the operational style and values of the homes? *
Q4 – Team Around the Child (ITAC) Working: Clinical support is a key part of ITAC, working alongside the Registered Manager, staff team, and external professionals. What would you see as your fundamental contributions to partnership working, improving outcomes, and tracking progress for young people?*
Q5 – Strategic Development and Action Planning: Describe a time when you identified a need for improvement or development in a service. How did you create and implement an action plan? What steps did you take to monitor its effectiveness and adapt it, and what was the impact on the service or organisation?
Q6 – Therapeutic Approach and Evidence-Based Practice: Which therapeutic models or approaches do you primarily draw upon when supporting children and young people who have experienced trauma? How do you adapt your approach to meet the needs of individual children within a residential setting?
Q7 – Supervision, Training and Reflective PracticePart of the role is to support the professional development of the staff team. How would you deliver clinical insight through training, informed & reflective practice, or supervision, in order to build staff knowledge and resilience?
Do you currently hold professional indemnity insurance?
Publications, Research and Professional Contributions (optional): If applicable, please list any publications, research projects, conference presentations, or other professional contributions that you feel are relevant to this role. You may include links, references, or brief summaries as appropriate.
Have you received any driving convictions and or penalty points in the last 3 years? *
Details:
Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offend ers Act 1974 (Exceptions) Order 1975 (as amended in 2013)?*
If you have answered yes to the above question, we will send a Rehabilitation of Offenders form for you to complete. After you have completed this and sent back, we will review and update you of the process .The post for which you have applied is defined as exempted employment within the terms of The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013). You are therefore required to declare any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Act, whether or not they would be, in terms of the Act, classed as spent. Declaration of any convictions will not necessarily bar you from employment, as this will depend on the circumstances and background to your offence(s). All applicants who are offered employment will be subject to a criminal record check before the appointment is confirmed. See The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) page for details of how to check what information is required under the new legislation.
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)
At Brinscall Care, we actively promote equality of opportunity and welcome applications from people with the right mix of talent, skills and potential – including those who may have a criminal record. All candidates are selected for interview based on their skills, qualifications and experience.

Under current legislation in England and Wales, some old and minor cautions or convictions are classed as ‘protected’and do not need to be disclosed. These will not be taken into account when making recruitment decisions. However:

Cautions and convictions for certain serious violent, sexual, or other offences relevant to safeguarding children must always be disclosed.
All convictions resulting in a custodial sentence (including suspended sentences) must always be disclosed.

If an individual has more than one conviction, none will be classed as protected.
Guidance on which offences are protected (and therefore do not need to be disclosed) can be found here:

DBS-filtering-guidance

Disclosure and barring information

What this means for you
If you are offered employment, you will be required to complete an enhanced criminal record check through the Disclosure and Barring Service (DBS) before your appointment is confirmed. You must declare any convictions, cautions, reprimands, or final warnings that are not protected under the Act.

A criminal record will not automatically prevent you from working with us. We will consider:
- The nature of the offence(s)
- How long ago it occurred
- Its relevance to the role applied for
- Any other information you provide
Unless prohibited by law (for example, under the Protection of Children Act 1999), we will assess all information fairly.

Process

Since DBS certificates are now only sent to the applicant, we may ask you to show your copy to us so we can review any relevant information.

You will have the opportunity to discuss any details before a decision is made.
Failure to disclose any required (unfiltered) information may result in withdrawal of an offer or disciplinary action, including dismissal.

Confidentiality

Any disclosure form will only be reviewed after shortlisting.
If you are successful, the form will be stored confidentially on your personnel file.
If you are unsuccessful, the form will be securely destroyed after six months, in line with our data protection policy.

Important: It is illegal for a person barred from working with children by the DBS to apply for any position within Brinscall Care.
Details of incident
Date of incident *

MonthDayYear
Date
Is the conviction spent or unspent?*
I confirm that the caution(s) and/or conviction(s) listed below has/have been imposed on me. (Please give details of the offence, the date and whether it is spent or unspent)*
DECLARATION
I understand that appointment to this post is conditional on the information supplied with my application being correct and that if I have withheld any information or any information is found to be false, I will be liable to disciplinary action.

• The statements made by me in this application form and on any additional forms supporting my application are true to the best of my knowledge.

• I hereby consent to the processing of the above data in accordance with the current Data Protection legislation.
Print name to acknowledge the above:

First NameLast Name
Should be Empty:

	Employer name	Role carried out	Date from:	Date to:	Email:
Reference 3
Reference 4
Reference 5
Reference 6

Psychotherapist (Clinical Support Role)

DECLARATIONI understand that appointment to this post is conditional on the information supplied with my application being correct and that if I have withheld any information or any information is found to be false, I will be liable to disciplinary action.

• The statements made by me in this application form and on any additional forms supporting my application are true to the best of my knowledge.

• I hereby consent to the processing of the above data in accordance with the current Data Protection legislation.

DECLARATION
I understand that appointment to this post is conditional on the information supplied with my application being correct and that if I have withheld any information or any information is found to be false, I will be liable to disciplinary action.