START

Thank you for your interest in undertaking a volunteer counsellor placement at the Centre for Better Health. Before starting your application, read the Volunteer Counsellor Role Description including the section headed "Considerations before applying" and tick to indicate you have done so.

PERSONAL DETAILS



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

Gender:
Gender Self-Description:

Employment Status:

Current Address




Borough:

If you are from outside of London, please indicate where from below:



Can we leave a voicemail?:

EMERGENCY CONTACT

Please provide the details of a person to contact in case of emergency. This can be someone who is supporting you through another service, or a friend or family member. Please ensure that the emergency contact is someone who is often available

Emergency contact:
Emergency contact relation to you:
Emergency contact phone number:

Please confirm that this information has been provided:

EDUCATION

Name of school:
Dates attended to/from:
Qualification(s) gained:
Name of university / college (if applicable):
Dates attended to/from:
Qualification(s) gained:
Other qualifications:

Counselling Training

Name of current training institute:
Address of current training institute:
Which qualification are you studying for?:
Which year are you currently in?:
Areas of interest or additional training:
Professional orientation:
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 you were on placement with us if you are successful:

WORK AND VOLUNTEERING

Current employer:
Current employer address:
Position held:

Relevant work experience (paid or voluntary)

Experience 1

Organisation:
Address:
Position held:
Dates to/from:

Experience 2

Organisation:
Address:
Position held:
Dates to/from:

Experience 3

Organisation:
Address:
Position held:
Dates to/from:

SKILLS AND EXPERIENCE

Please read the role description for the role you are applying for, prior to completing this section.

What relevant skills, knowledge and experience do you have?:
What personal qualities can you bring to this role?:
What experience do you have working with adults with low wellbeing or mental ill health?:
Why do you want to volunteer for the Centre for Better Health?:

AVAILABILITY

Daytime counsellors see four clients from 9am-1pm or from 1pm-5pm weekly. Group supervision takes place fortnightly, on the same day (either 10am-12pm or 2pm-4pm, depending on whether you see clients in the morning or afternoon. Therefore, please ensure you offer at least one full day when indicating your availability.

Evening counsellors see three clients from 5pm-8pm weekly (Tuesday-Thursday only). Group Supervision takes place fortnightly, usually on another evening. Owing to our timetabling, all evening counsellors must have availability on a Wednesday and one other evening.

We require volunteer counsellors to commit for two years.

When would you be available to start?:
Please indicate your availability

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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. Note that our volunteer placements are exempt from the Rehabilitation of Offenders Act 1974.

DBS check

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 adults*

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).

Academic reference

Name:
Email:
Job title:
How is this person known to you?:

Your current or most recent employer

Name:
Email:
Job title:
Is this your previous or current line manager?

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?:
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?:

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 service?:

Ethnicity:
Ethnic Category- Other:

Religion or Belief:
Other Religion or Belief:

Sexual Orientation:
Other Sexual Orientation:

Housing Status:
Other Housing Status:

Relationship Status:

First Language
Experience of criminal justice system:

END

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 have provided in accordance with the Data Protection Act 2018. You can read our Privacy Notice for information on how we handle your data.

Please type your name below to confirm that you agree to your data being stored and processed by the Centre for Better Health.

Consent:

Communication Preferences:

If your application is successful, we would love to keep in touch with you during your volunteering to keep you in the loop with what's going on at the Centre for Better Health. Emails may include positive outcomes from the service, surveys to get feedback on your volunteering experience and information about internal events and changes.

I would like to receive information from the Centre for Better Health by email:

If you tick 'no', we will still need to communicate with you via the email address you have provided regarding your application and your volunteering role if you are successful.

We may use Mailchimp to send you emails. By opting in to receive emails from us, you acknowledge that your information could be transferred to Mailchimp for processing. You can change your mind by clicking the unsubscribe link in the footer of any email you receive from us via Mailchimp or by contacting reception@centreforbetterhealth.org.uk

To submit your application click "SUBMIT"