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  • Counsellor Application Form

    This application form is in three sections:

    1. Counsellor Information

    2. Police Vetting

    3. Terms and Conditions

  • 1. Counsellor Information

    The information given in this section may be shared with Victim Support frontline staff and clients in the interests of matching clients with suitable counsellors.

  • Criteria for becoming a registered counsellor with Victim Support:

    • You must:
      • practice counselling. 
      • hold a current Annual Practising Certificate (APC) for counselling with a recognised professional body within country of practice.
    • If you do not practice counselling as your main practice area but you are qualified in other relevant areas of expertise such as social work with counselling components; child play; music therapy; or traditional Maori or Pasifika therapies etc, registration will only be considered on a case-by-case basis. These therapies currently also require an APC with a recognised professional body within country of practice. 
    • Police Vetting results relevant to 'in country' requirements are required to be provided to Victim Support. Examples include (but are not limited to) - Police and Character Clearance Report (Australia), Certificate of Good Conduct or Lack of a Criminal Record (USA).

  • Criteria for becoming a registered counsellor with Victim Support:

    You must:

    • practice counselling; 
    • hold a current Annual Practising Certificate (APC) for counselling with a recognised professional body within country of practice. This includes NZAC/ANZASW/DAAPANZ; and
    • be Police vetted with a 'no results' report.

    Note: If you are not a member of a recognised professional body please DO NOT continue this application process. Please reach out in the first instance by email to counselling@victimsupport.org.nz

    • If you do not practice counselling as your main practice area, but you are qualified in other relevant areas of expertise such as social work with counselling components; child play; music therapy; or traditional Maori or Pasifika therapies etc, registration will only be considered on a case-by-case basis. These therapies currently also require an APC with a recognised professional body within country of practice.

  • Consulting Address

    This is the address you practice from and will be provided to potential clients to help them choose a counsellor.
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  • Other address (optional)

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  • 2. Police Vetting

    Victim Support vet potential counsellors to help ensure the safety of clients who wish to receive counselling services. The information provided in this section is for Police Vetting purposes only. It is not viewable by Victim Support frontline staff or clients. The information requested is required by New Zealand Police to be inputted into a form by Victim Support so that Police can complete vetting on Victim Support's behalf. Please note: the Police process is outside of the control of Victim Support and can take up to 6 weeks.

  • 2. Police Vetting

    Victim Support vet potential counsellors to help ensure the safety of clients who wish to receive counselling services. The information provided in this section is for vetting purposes only. It is not viewable by Victim Support frontline staff or clients. 
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  • If you do NOT have a completed POLICE VETTING (with the last 12 months), please fill in the Police Vetting information fields below. 

    Police Vetting Information:

    Further information regarding the Police Vetting process can be found here. https://www.police.govt.nz/advice-services/businesses-and-organisations/nz-police-vetting-service

    Following the receipt of your Police Vetting result, Victim Support will note on its records that vetting was completed and the result. The other Police vetting information that you have submitted (other than your identity details for registration records) will be deleted. 

     

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  • Criminal and Driving Record Information
    Please note Police Vetting is subject to the Criminal Records (Clean Slate) Act 2004

    Under the Criminal Records (Clean Slate) Act 2004, you do not need to declare a New Zealand conviction if all of the following apply:
    • It has been 7 or more years since your most recent conviction and you have not re-offended; and
    • You have never had a custodial sentence imposed upon you (including detention at home, in hospital or at any secure facility); and
    • You have paid any fines/costs/compensation/reparation.


    However, regardless of how long ago you were convicted, you are not eligible to conceal your conviction if:
    • You have ever been convicted of a sexual offence; or
    • You have ever been disqualified from holding a driver license for repeat offending involving alcohol/drugs; or
    • The conviction was from overseas.

  • Australian Police Vetting Consent Section:

     

    If you have lived in Australia over the last 10 years, you will need to undergo an Australian Police Vetting check. This information will be forwarded to the Australian Police to enable this to occur. 

  • Residential Address in Australia:

  • Applicant’s consent to release information:

    Please read the Consent for Police Vetting here : https://www.police.govt.nz/sites/default/files/publications/user-guide-to-pvs-vetting-request-consent-form.pdf

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  • Evidence of Identity

  • To be satisfied that we know who you are, you will need to provide the following:

    • Copies of TWO forms of ID (one must be photographic)
      AND
    • a photograph of you holding your photographic ID.

  • * Please provide head and shoulders photograph without glasses. Name and ID number of the photographic ID must be clearly legible.

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  • 3. Terms and conditions

  • I agree to and understand the following when I submit this form:

    • My Police Vetting information is current and up-to-date at the time of submitting this form.
    • Whilst initial vetting is undertaken by Victim Support, it is not a requirement to complete additional Police Vetting as a registered counsellor. I understand that I have a responsibility to advise Victim Support of any matters that may impact on my suitability to provide services to clients, including if I am convicted of an offence  in the future.
    • I have provided all the material asked for, and that Victim Support may check my APC with the relevant organisation/s annually or as required.
    • I am providing information in respect of my services to Victim Support so that Victim Support can provide that information to clients to assist them in selecting a counsellor to work with.
      • Clients may receive my name, gender, ethnicity/iwi affiliations, preferred practice areas/areas of expertise, consulting address, and contact details.
      • These details (minus the Police Vetting information excluding the result) is held on file by Victim Support and may be disclosed to the Ministry of Justice as part of compliance reporting.

    • I have read Victim Support’s privacy and confidentiality webpage - Privacy & Confidentiality

    • I reserve the right to work with clients, to end counselling when it is apparent that counselling is no longer helpful, no longer appropriate, or for other relevant reasons. Where necessary and feasible, I shall refer clients to other counsellors who may be more appropriate.

  • If approved as a Victim Support counsellor:


    • I will send a copy of my annual practicing certificate when it is renewed each year to VAS Administrator, NZ Council of Victim Support, PO Box 3017, Wellington 6140, fax 04 495 3076 or
    counselling@victimsupport.org.nz

    • I will only charge Victim Support the agreed fee and will not make any additional charges to the client, unless there is agreement between all parties prior to commencing counselling.

    • I will not exceed the approved number of sessions available to clients referred to me. If I believe more sessions are required, this will be considered on a case by case basis, dependent on the funding criteria and the circumstances of the client. I will send requests for more sessions to the VAS Administrator at counselling@victimsupport.org.nz if this is the case.

    • I understand I will not be paid for any sessions that are not approved by Victim Support.

    • I am willing to liaise with Victim Support employees on matters related to the
    administration of the Victim Assistance Scheme (the scheme that pays counsellors for victims of crime).

    • I understand that if I hold professional insurance/indemnity, it is my responsibility to provide services as required under my insurance.

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