Volunteer Counsellor Application Form

    Section 1 - General


    DAYEVENINGON MOBILE
    21-3030-4545-6060+

    If No, please go to Section 3.   If yes, continue with Section 2.

    Section Two - Counselling Placements


    YESNO
    YESNO
    YESNO

    Section Three - General Continued


    YESNO

    YESNO
    YESNO

    MORNING – Monday/ThursdayEVENING - Monday/Tuesday/Wednesday/Thursday

    YESNO

    MORNINGSAFTERNOONSEVENINGS

    MORNINGSAFTERNOONSEVENINGS




    References


    PLEASE SUPPLY US WITH TWO REFERENCES [If this is for your counselling placement, one of these should be your supervisor or tutor]

    First Reference (Supervisor/Tutor if applicable)

    Reference - PERSONAL

    YESNO

    IMPORTANT INFORMATION FOR TRAINEE COUNSELLORS ON PLACEMENT

    Please read the following carefully before applying to ensure that BEREFT is an appropriate placement for you.

    TAPING

    We do not give blanket permission to tape record BEREFT counselling sessions. BEREFT clients will need to give written permission to be taped.

    CASE STUDIES AND EXTERNAL SUPERVISION [PEER OR INDIVIDUAL]

    Clients must give written permission [there is a set procedure for this] if counsellors wish to use case study material in their training.

    NB: Above points can be discussed in more detail at interview.

    CONFIDENTIAL

    DISCLOSURE FORM FOR VOLUNTEER COUNSELLORS

    Because you may be seeing clients in their own home we need you to answer the following question. Please be assured that this is in confidence and will not necessarily exclude you from being a volunteer.

    YESNO

    NB: The possession of a conviction will not necessarily debar you from becoming a volunteer counsellor unless BEREFT considers that your conviction[s] render you unsuitable. In making this decision we will consider the nature of the offence/how long ago it was committed/what age you were at the time and any other relevant factors.

    Failure to disclose any criminal offences could lead to either your application being rejected or if you have become a counsellor to immediate release from BEREFT