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Thank you for your interest in volunteering for the Centre for Better Health.
Please complete the following application as thoroughly as you can.

Volunteer Role Selection:
Where did you hear about us?:



Date of Birth:
Gender:
Gender - self description:


Borough:
Address Postcode:


Emergency Contact Name:
Emergency Contact Phone Number:

EDUCATION

Name of School:
School - Years of Attendance:
Name of University / College Attended:
University / College Years of Attendance:
Degree(s) Obtained:
Other Qualifications:

COUNSELLING/ PSYCHOTHERAPY TRAINING

For those applying for a counselling placement, give details of your training and experience

Name of Current Training Institute:
Address of Current Training Institute:
Professional Organisations:
Years of Training:
Areas of interest or additional training:
Current Number of Clinical Hours:

EMPLOYMENT AND VOLUNTARY WORK EXPERIENCE

Employment Status:
Current Employer:

Please give us information about any relevant work experience including voluntary work

Position Held:
1. Voluntary Experience Organisation:
1. Voluntary Exp Organisation Address:
1. Voluntary Experience Nature of Work:
Start and End Date:
2. Voluntary Experience Organisation:
2. Voluntary Exp Organisation Address:
2. Voluntary Experience Nature of Work:
3. Voluntary Experience Organisation:
3. Voluntary Exp Organisation Address:
3. Voluntary Experience Nature of Work:

SKILLS AND EXPERIENCE

Relevant Practical Skills and Experience:
Personality Traits Suitable for Work:
Experience Working in Mental Health:
Why do you wish to volunteer your time?:
What do you hope to gain from the exp?:
Organisation/department/team:

AVAILABILITY

Please complete availability section A. if you are applying for a counselling placement and B. for any other volunteer position

A. Please note that we require a weekly time commitment of four consecutive hours to see clients and two hours fortnightly for group supervision. We require volunteer counsellors to commit to a minimum of one year up to two years.

Daytime Monday:
Daytime Tuesday:
Daytime Wednesday:
Daytime Thursday:
Daytime Friday:
Evening Tuesday:
Evening Wednesday:
Evening Thursday:
Start and End Date Availability:

REFERENCES AND CHECKS


Please provide the details of two referees;

IMPORTANT: Applicants for a counselling placement should provide one reference from either previous or current line manager and the other should be an academic reference in relation to your counselling/psychotherapy training.

1. Referee Name:
2. Referee Address:
1. Referee Job Title:
1. Referee- Relationship to You:
2. Referee Name:
1. Referee Address:
2. Referee Job Title:
2. Referee- Relationship to You:

Do you have any spent or unspent criminal convictions, cautions, reprimands or warnings? This volunteer placement is exempt from the Rehabilitation of Offenders Act 1974

Do you have any criminal convictions?:
If yes, please give details:

Note: Please be aware that an offer of a placement is based on satisfactory references and DBS checks

Do you have a current DBS Certificate?:

For volunteer counsellors:

CBH require you to receive external supervision in addition to receiving group supervision while in placement with CBH.

You will also be required to hold a Professional Liability Insurance.

OTHER INFORMATION:

Optional: you do not need to fill in the following questions if you do not wish to, however we appreciate if you do, as it helps us to ensure that our services reach the widest possible audiences and that they are available to sections of the public that may be underrepresented. This part of the application will be kept separately and anonymously for monitoring purposes only.

Ethnicity:
Ethnicity Sub Category:
Religion or Belief:
Other Religion or Belief:
Sexual Orientation:
Other Sexual Orientation:

CONSENT

Thank you for completing this application, we use all information in accordance with the data protection act.

Kindly type your name below to consent to your information being processed by us.

Consent:
Mailing list:

Please click here to access our policy about how your personal details will be handled.

You can withdraw your application at any time by emailing services@centreforbetterhealth.org.uk