Volunteer Counsellor Application Form

Volunteer Counsellor Application Form
Thank you for your interest in undertaking a volunteer counsellor placement at the Centre for Better Health. Before starting your application, please read the Volunteer Counsellor Role Description, including the section headed 'Considerations before applying'.
Data protection
The Centre for Better Health needs to collect this data about you in order to assess your suitability for a volunteer placement. We will use the information that you provide in accordance with the Data Protection Act 2018 and our Privacy Notice.
Please check this box to confirm that you agree to your data being stored and processed by the Centre for Better Health.*

I agree
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Emergency Contact Details

Please provide the details of a person to contact in case of emergency. This can be a friend or family member. Please ensure that the emergency contact is someone who is often available.
Emergency Contact Name*
Relation to you*
Emergency Contact Phone number*
Please enter a valid phone number.
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Counselling training
Name of current training institute*
Name of course/qualification*
Which year are you currently in?*
Areas of interest or additional training*
Counselling modality*
How many supervised 1:1 client hours do you have?*
Please detail any placement requirements that your course provider will ask us to comply with if your application is successful*

The volunteer role
What relevant skills, knowledge and experience do you have?*
What experience do you have working with adults with low wellbeing or mental ill health?*

Support Needs
Do you have any disability, audio or visual impairment, mobility issues or any other support needs?*

YesNo
Please provide any further information that may be helpful for us to be aware of.
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References and Checks

If you are offered a placement, this will be conditional until we receive two satisfactory references and a Disclosure and Barring Service (DBS) check.
DBS

Note that our volunteer placements are exempt from the Rehabilitation of Offenders Act 1974.
Are you registered with the DBS online update service (the certificate you have registered should be an enhanced check to work with adults)?*

YesNo
References

Please provide the details of two referees. One should be a professional reference (your current or most recent employer) and the other an academic reference (your current or former counselling training institute)
Name - Reference 1*
Email - Reference 1*
example@example.com
Job title - Reference 1*
How is this person known to you? - Reference 1*
Name - Reference 2*
Email - Reference 2*
example@example.com
Job title - Reference 2*
How is this person known to you? - Reference 2*
External supervision

CBH requires you to receive external supervision in addition to the group supervision you will receive while on placement with us.
Do you have an external supervisor?*

YesNo
External Supervisor Name
External Supervisor Contact Details
Insurance

We also require counsellors to hold their own professional indemnity insurance for the duration of their placement with us.
Do you hold insurance?*

YesNo

Diversity Monitoring

We are committed to ensuring that the clients and volunteers we work with reflect the diversity of our community, and that barriers that prevent underrepresented groups from accessing our services are gradually identified and removed. To help us to do this, we encourage you to answer the below questions.
How did you hear about our counselling placements?
Ethnicity
If you selected 'Other', please state
Sexuality
If you selected 'Other', please state
First Language
Please note that we only offer counselling in English
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Personal Details