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Qualifiedvolunteerapplicationformrenew2013

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					                          Volunteer Application Form

      Please fill in ALL sections
      Please do not attach your CV as it will not be considered
      Complete in BLACK ink or typescript and sign the declaration on your last page
       (if you email your form you will be asked to sign it at interview, if applicable).

Vacancy Information
Job Title: Adult /Child & Adolescent Volunteer Counsellor (please delete as appropriate)
Centre: Sycamore/Bridge/Schools (please delete as appropriate)

Personal Information
Title (Mr, Mrs, Ms, Miss etc):                 Surname:
Forenames(s):                                  Known As:
Address (incl. postcode):



Daytime Tel No:                                 Evening Tel No:
Mobile Tel No:                                  Home Email Address:
Preferred means of contacting you: Daytime/Evening/Mobile/Email/Any (delete as
appropriate)
If you are not a British or EU national, do you have any restrictions on your right to work
in the UK? Yes/No

Please provide details of working visas, work permit requirements etc.



Have you ever worked/applied to work for Renew Counselling (formerly ‘WHCM
Counselling’) in the past? Please give details: (include paid and voluntary posts)
Education & Qualifications (most recent first)
Name of                           Dates attended    Subjects                Qualification and
school/college/university/other   (month/year)                              grade




Other Training Courses Attended
Establishment & Course Title         Date & Length of course   Qualification gained (if applicable)




Professional Membership (for clinical staff only)
Are you a member of any professional body? Yes/No If so, please provide relevant
details:

Body                                 Status/Accreditation      Joining Date
                                     number




It is a requirement that all qualified Counsellors/Therapists are registered on either the
BACP Voluntary Register, or on another recognised statutory register (e.g. Health and
Care Professional Council (HCPC)). Please confirm below that you are registered on an
approved register:

Are you registered on an approved Voluntary or Statutory Register: Yes/No If so, please
provide relevant details:

Body                                 Voluntary/Statutory       Joining Date
                                     Register No.
Clinical Hours (for clinical staff only)

Please confirm below how many supervised counselling/supervision you have
completed, ensuring that you highlight whether the counselling was with child and/or
adolescent, or adult clients.

For Counsellors:

                                                With Children and/or                   With Adults
                                                    Adolescents
No. of supervised counselling hours
completed

For Supervisors:

                                            With reference to Children               With reference to
                                               and/or Adolescents                         Adults
No. of hours supervision facilitated
(if applicable)

Employment History
Please give details of your employment, starting with your current or most recent
employer and working backwards. Please account for any gaps in your employment
history. Please use an additional sheet if necessary.

Employer’s name,       Dates           Job title, main duties and responsibilities    Reason for leaving,
address and business   employed                                                       notice period and
type.                  (month/year)                                                   final salary.
Experience and Skills

Please use this section to tell us a little about yourself, your experience, and skills &
knowledge and why you wish to volunteer for Renew Counselling.
References
Please provide the details of two professional referees. One of them should be your
current (or most recent) employer or your current educational establishment. Neither will
be approached without your prior permission.

Name:                                         Name:
Position:                                     Position:
Organisation/Company:                         Organisation/Company:

Address:                                      Address:


Telephone No:                                 Telephone No:
Email address:                                Email address:
What is your relationship with this person?   What is your relationship with this person?

When may we take up references?               When may we take up references?

Before Interview/After Interview              Before Interview/After Interview

Where did you first hear about the position?
Web: Which site               Press: Which name              Other:


Please state days of week you are able to do this work:
Criminal Convictions
As this post involves substantial, unsupervised contact with children, young people and/or
vulnerable adults all applicants who are offered an appointment will be asked to submit to a
criminal records check before the position can be confirmed. You will be asked to apply for an
Enhanced Disclosure through the Disclosure and Barring Service (DBS) (England & Wales).

As the position is exempted under the Rehabilitation of Offenders Act this check will reveal details
of cautions, reprimands or final warnings, as well as formal convictions not subject to DBS
filtering rules. Because of the nature of the work for which you are applying, this position is
exempt from the provision of section 4(ii) of the Rehabilitation of Offenders Act 1974 (Exemptions
Orders as applicable within the UK), and you are not entitled to withhold information about
convictions which for other purposes are ‘spent’ under the provisions of the Act with the exception
of those that are subject to the DBS filtering rules. In the event of appointment, any failure to
disclose such convictions could result in the withdrawal of approval to work with children or
vulnerable adults within the organisation.

This process is subject to a strict code to ensure confidentiality, fair practice and security of any
information disclosed. The DBS Service Code of Practice and our own procedures are available
on request for you to read. It is stressed that a criminal record will not necessarily be a bar to
appointment, only if the nature of any matters revealed could be considered to place children or
vulnerable adults at risk. As an organisation we agree to abide by the Code of Practice on the use
of personal data in employee/employer relationships under the Data Protection Act 1998 as well
as the expectations of the DBS Service.

As a condition of employment we ask that you keep us informed of any other work (either paid or
voluntary) which you are undertaking that involves working with children or vulnerable adults.
Should we ever need to refer an individual to any of the lists of people deemed unsuitable for
working with children or vulnerable adults then we would also inform them of any knowledge we
have of that individual working in any other capacity with children/vulnerable adults.

Under the Protection of Freedoms Act 2012 it is an offence for any organisation to offer
employment to anyone who has been convicted of certain specific offences, or included on either
of the two barred lists held by the Disclosure and Barring Service where the post falls within the
scope of regulated activity (as defined by the DBS, under the Safeguarding Vulnerable Groups
Act 2006 and the Protection of Freedoms Act 2012). An enhanced with barred list check must be
completed. Those working with children and / or vulnerable adults in posts which fall outside the
scope of regulated activity may still be eligible for an enhanced disclosure WITHOUT a barred list
check.

Do you have an unspent criminal offence, caution, reprimand or warning (according to
DBS filtering rules, and Rehabilitation of Offenders Act 1974) (please circle): YES / NO

If YES, please give details on a separate piece of paper and returned in a separate
envelope with this application marked for the confidential attention of the recruiter.

Those applying for work with children and/or vulnerable adults in positions which fall
within the scope of regulated activity please confirm whether you are barred from
working with children/vulnerable adults (please circle): YES / NO

NB: Those applying for work with children and/or vulnerable adults in positions which fall
outside the scope of regulated activity should not complete the declaration above.
Statement of Confirmation
I declare that the information given in this application is correct to the best of my belief. I
declare that I have no past convictions, cautions or bind-overs and no pending cases
that I have not brought to your attention which may affect my suitability to work with
children, young people or vulnerable adults. I understand that should any information be
false, a job offer may be withdrawn or I may be subject to summary dismissal.

The information provided by you on this form as an applicant will be stored on paper
records or a computer system in accordance with the Data Protection Act 1998 and will
be processed solely in connection with recruitment.


Signed _______________________________________                  Dated _________________



Your completed application form should be returned to:

Emma Bacon
Renew Counselling
Sadlers House
2 Legg Street
Chelmsford
Essex CM1 1AH

Or emailed to emma@renew-us.org

				
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