YMCA DownsLink Group
Application for Volunteer Counsellor Placement
Date of Application:Placement Applying for:
Job Reference:
Name:
Address:
Telephone No: / Mobile No:
Email:
Would you like to join our recruitment emailing list? We will send details of vacancies and recruitment days via email, and you can opt out at any time. This does not affect your application.
Yes/No
Please tell us where you heard about the counselling placement scheme
Educational Qualifications
Course Provider name and address / Dates / Qualification / Level achieved
Counselling Qualifications
Course Provider name and address / Date Awarded / Qualification
e.g. BA Hons Counselling / Level achieved
e.g. Distinction
Ongoing Training
Course Provider name and address / Dates
include predicted finish date / Qualification Level
e.g. BA Hons Counselling / Course details
Current Employment (including job title, main responsibilities and dates of employment and name ofemployer and include voluntary work):
Current Employer:
Start Date:
Job Title:
Main responsibilities:
Employment History (please list job title, main responsibilities, dates of employment and name of employer. Include voluntary work and information about gaps):
Employer details / Job Title / Start and end dates / Main responsibilities
If you are a student member/member of a professional body please give details:
Organisation:
Membership Number:
Membership type:
Expiry Date:
Counselling Experience:
If in training, do you have any course requirements that must be met by this placement?
Please bear the following in mind:
We provide integrative supervision
We consider on a case-by-case basis recording and case studies for 16+ years only, and it is not guaranteed. We cannot guarantee working with a particular age group.
Details of personal counselling / therapy (including approximate dates and orientation of counsellor / therapist):
May we have your permission to contact your current / most recent clinical supervisor?
Y / N
Name: / Address:
Personal Statement
Please describe below any relevant experience you have with young people, and provide any other information to support your application. Please refer to the placement information leaflet for further information. This is an important part of the application form and it is in your best interests to use it fully. You may attach separate sheets to your application if you wish.
References
Please supply details of two referees who are able to comment on your abilities and experiences that are relevant to this application. If you are in-training or recently qualified a college tutor would be an appropriate referee. Friends and family members would not be appropriate referees.
1. Name: / Job Title:
Address:
Email Address:
Telephone No:
Please state the capacity in which you know this person:
2. Name: / Job Title:
Address:
Email Address:
Telephone No:
Please state the capacity in which you know this person:
Please return this form to orpost to:
Volunteer Counselling Coordinator
Dialogue Therapeutic Services
Reed House
47 Church Road
Hove
BN3 2BE
Counselling at YMCA DownsLink Group involves working directly with young people. If your application is successful you will be required to complete a Disclosure & Barring Service check before you can begin any placement.
General Data Protection Regulation:
Please note that it is our policy that all recruitment documents, including application forms, for unsuccessful applicants, are kept in secure conditions for a period of 6 months, after which they will be securely destroyed.
I give my consent for YMCA DownsLink Group to keep my data for up to 6 months for the purpose of recruitment to the role applied for and for consideration for any other suitable vacancies that may arise during this time.
Please tick here to give your consent
If I accept a volunteer counselling placement with YMCA DownsLink Group, I consent to my personal information being held securely by the organisation for the purpose of the administration of my role and agreement with YMCA DownsLink Group Please tick here to give your consent
Signed:______Date:______Name:______