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Thank you for your interest in joining the team of volunteer counsellors for the Centre for Better Health.
Please complete the following application as thoroughly as you can.




Date of Birth (submit as dd/mm/yyyy):

Address




Borough:

Contacts



EDUCATION

Name of School:
Dates To/From:
Name of University / College Attended:
Dates To/From:
Degree(s) Obtained:
Other Qualifications:

Counselling Training

Name of Current Training Institute:
Address of Current Training Institute:
Which qualification are you studying toward?
Areas of interest or additional training:
Professional Orientation:
Current Number of Clinical Hours:

EMPLOYMENT AND VOLUNTARY WORK EXPERIENCE

Employment Status:
Current Employer:
Position Held:

Relevant Work Experience (paid or voluntary)

Experience 1

Organisation:
Address:
Nature of work or position held:
Dates To/From:

Experience 2

Organisation:
Address:
Nature of work or Position held:
Dates To/From:

Experience 3

Organisation:
Address:
Nature of Work or Position held:
Dates To/From:

SKILLS AND EXPERIENCE

What are your practical skills and experience?
Which of your personality traits do you consider most suitable for this work?
What is your experience of working with adults with mental health problems?
Why do you wish to volunteer your time as a counsellor with The Centre for Better Health?
What do you hope to gain from your experience?:

AVAILABILITY

We require a weekly time commitment of four consecutive hours to see clients during the day and 3 hours for evening counselling as well as two hours fortnightly for group supervision.
We require volunteer counsellors to commit to a minimum of one year up to two years.

When would you be available to start:
Please indicate your availability by answering either yes or no for each option:
Morning slot is: 9am -1pm
Afternoon slot is: 1pm-5pm
Evening slot is: 5pm-8pm

Mon Morning:

Tue Morning:
Tue Afternoon :
Tue Evening:

Wed Morning:
Wed Afternoon:
Wed Evening:

Thur Morning:
Thur Afternoon:
Thur Evening:

Fri Morning:
Fri Afternoon:

REFERENCES AND CHECKS

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

DBS check

This volunteer placement is exempt from the Rehabilitation of Offenders Act 1974

Do you have any spent or unspent criminal convictions, cautions, reprimands or warnings?
If yes, please give details of your criminal Conviction(s):
Are you registered with the DBS online update service*?
* the certificate you have registered should be an Enhanced Check to work with Adult

External supervision

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

Do you have an external supervisor:

Insurance

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

References

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.

Academic reference

Name:
Email:
Job title:

Work or placement reference

Name:
Email:
Job title:

OTHER INFORMATION:

How did you hear about us?:

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.

Gender:
Gender - self description:
Ethnicity:
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:

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