/ Volunteer Lifeline Telephone Crisis Supporter 2017A

Expression of Interest – Crisis Supporter Workplace Training (CSWT)

Please type in the fields below. Place your curser at the beginning of the line in each section and type your response. Additional space will automatically be created as required.

Expression of Interest must be returned as soon as possible

Applicant Information

Full Name: /

Last

/

First

/ /

Birth Date

Address:

Street Address

/

City/Suburb

/

State

/

Post Code

Phone: / (M) (H)
Email:
Have you applied to do the Lifeline training before? / YES / NO /
If yes, when and at which center?

Education

References

Please list two people who have known you for at least two years and can evaluate your work and character. These referees will preferably know you in a professional capacity and should be aware that you have nominated them as referees. It is important that you indicate your relationship with your referees.

Full Name: /
Phone:
Position Description/Title:
Relationship:
Full Name: /
Phone:
Position Description/Title:
Relationship:

Skills, experiences, life events

Please describe the life events, experiences or skills you have that you believe will make you an effective Lifeline Telephone Crisis Supporter. We want to know to know about you as a person, what has shaped you and how you have reached the position of wanting to be a TCS. At least half a page is acceptable to us.

Medical Conditions

Do you experience any physical or mental health condition that may impact of your capacity to undertake the training and/or practice as a TCS? We ask so that we may work with you to include you, not exclude you.

Significant stress or loss

During the past year, have you, your family or anyone close to you experienced significant event, loss or stress? Please provide details of the event and how recent it was.

What do you expect to gain from becoming a TCS?

Your accessibility and availability

Are you familiar with and have access to a computer? / YES / NO /
Do you have access to the internet? / YES / NO /
Are you able to attend all the training modules? / YES / NO

Are you available for an interview between Monday and Friday 9am-5pm, if required?

YES / NO

Lifeline Ballarat operates from 6.30am-10.30pm 7 days a week. Shifts are of 2 or 3 hours duration. The majority of available shifts fall in the early morning, early to late evening and weekends. Are you able to commit to undertaking ~3 shifts per month, in addition to other accreditation activities, for a period of 2 years?

YES / NO

Lifeline Ballarat Telephone Crisis Support Commitment

I acknowledge that I have received and read the Crisis Supporter Workplace Training Pre-enrolment Course Information. I understand that the training program will include face to face group sessions, group discussions, role playing, e-learning and other practical and written work. All these will be assessed in determining my suitability to progress to the following phase of the CSWT training, and ultimately my suitability to become a probationary or accredited Telephone Crisis Supporter (TCS).

I understand that prior to being invited to participate in the CSWT training I may be required to undergo a police check (at no charge to myself). I understand that if I accept an offer to participate in the CSWT training I am personally responsible for the payment of the co-payment fee as specified in the Crisis Supporter Workplace Training Pre-enrolment Course Information, and that failure to pay the fee may result in the offer to participate in the training being withdrawn.

I understand that if I accept a place in the CSWT training, I am committing to Lifeline Ballarat for a minimum of 2 years as a TCS, and to participating in and completing all accreditation activities required of the role. I will maintain the confidentiality of Lifeline Ballarat and undertake to comply with all policies and procedures of Lifeline Ballarat and Lifeline Australia.

Signed: /
Date:

2