1
The Place2Be, Wapping Telephone Exchange, Royal Mint Street, LondonE1 8LQTel: 020 7780 6189 Fax: 020 7481 1894
The Place2Train Application Form
Please refer to the ‘Guidance notes’on page 8 before completing your application.Complete this form using black ink or type. If there is not enough space in any section, please attach further sheets and mark them clearly with your name.
Personal details
First/Given Name(s)Surname/Family Name / Previous surname (if changed)
Title / Preferred name/ Known as
Address
Post code
Telephone number / Mobile number
Email address
How did you hear about this course?
Please return your completed application form and references to: Place2Be Training, 13/14 Angel Gate, 326 City Road, London, EC1V 2PT. If you have any queries regarding your application please contact Place2BeTraining on 020 7923 5535or via email to1
Relevant experience
Please tell us your experience of counselling and supervision. Please include non-therapeutic supervision such as supporting colleagues as line manager or coordinator
Context (paid employment, volunteering, parent or carer – starting with the most recent) / Brief description of duties(please remember to state whether any work was paid or voluntary) / Dates (from - to)Education and training
Training institution
(most recent first) /Course and type of qualification
(if applicable) /Dates
(from - to)Counselling or therapy training
Please note, you don’t need to have had any previous counselling or therapy training to apply for this course, but if you have it would be helpful for us to know about it.
Training institution
(most recent first) /Course and type of qualification
(if applicable) /Dates
(from - to)Supporting statement
Please answer all the supporting statement questions provided in the ‘Guidance notes’ (page 8).
References
Please give the attached reference form to two people (not relations) who will give you a personal reference. Include these references when you submit your application. If a referee is a Place2Be tutor/staff member, it is your responsibility to ask them that they provide this reference.
Your application will not be considered complete without the inclusion of two references.Please provide the details of your two referees below. Refer to the ‘Guidance notes’ (page 8) provided for more information.
First referee
Full Name
Relationship (e.g. employer, tutor, friend)
Address
Telephone
Email address
Second referee
Full Name
Relationship (e.g. employer, tutor, friend)
Address
Telephone
Email address
Disclosure of convictions
As the voluntary placement will involve access to children, the place is exempt from the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986 and you will be required to undertake an Enhanced Disclosure from the Disclosure and Barring Service DBSwhich will show all records. Please contact us if you would like further information.
Any place offered would be conditional on the receipt of an enhanced DBS which satisfies the criteria of Place2Be. A copy of the DBS Code of Practice is available on the DBS website.
* Do you have connections in your personal life with any individual (relative, household member or friend) who could present a risk to children or who has been convicted of a criminal offence which would deem them unsuitable to work with children?□ Yes□ No
* Have you, as an adult, had involvement with a local authority, in relation to care proceedings or child protection proceedings in your family?
□ Yes□ No
* Have you ever been arrested, cautioned for or convicted of a criminal offence or other offence which would show in a DBS enhanced disclosure?
□ Yes□ No
If YES, please give details and an explanation of the offence and sentence or penalty imposed (including suspended sentences, warnings etc) in a separate file marked ‘confidential’ including an explanation of how you have consequently demonstrated you are a suitable person to work directly with children.
The Disability Discrimination Act
What adjustments if any would be needed to assist you in carrying out this course, if accepted?Would any adjustments need to be made to the interview process to assist you in your application?
□ Yes□ No
If yes, please provide details:
Declaration
I declare that the information I have provided on this form is true and complete and that all questions relating to me have been accurately and fully answered.I understand that if it is subsequently discovered that any statement is false or misleading, or that I have concealed any relevant facts, my place will be withdrawn.
Signed:
/Date:
Guidance notes
These notes talk you through the kind of information needed to complete each section of the form. If you have any questions, please call us on 0207923 5558.
Personal details
Please complete all sections in full.
Relevant experience
Please outline your experience of therapeutic or supervision roles. This is not limited to supervision in a counselling environment.
Education and training
Please list any education or training that you have completed. You can also include any relevant short courses (lasting one day or more).
Counselling or therapy training
Please note, you will need to have the following experience and training:
To complete this course you will need to have at least 450 hours of counselling and therapeutic experience with clients before the start of this course and have been qualified at Diploma level or higher for at least 2 years. You will have had and continue to have supervision for your counselling work. You will also be expected to complete 15 hours of supervision of counsellors or therapists during the life of this course and have distinct supervision of your own supervision practice: at least 5 hours.
In addition it is important to be able to reflect ethical practice and professional standards and so learners should be able to demonstrate their adherence to principles laid out in the BACP ethical framework. As with most courses that involve the development of self-awareness and experiential learning this course is not suitable for those who are currently in a state of severe emotional difficulty and/or severe psychological confusion.
Supporting statement
Please consider the following questions and give brief answers to all of them:
- Why do you want to undertake this training and what do you hope to gain from the course? Why do you feel that now is the right time to begin?
- What skills and knowledge do you have terms of clinical supervision?
- What experience do you have in delivering supervision? are there any aspects of supervision that you plan to deliver in the future?
- How would you describe your experience of counselling training? How do you respond to feedback, experiential exercises, being observed in practice and being assessed?
- Describe some activities that you engage in which promote personal development and self awareness and outline how this benefits you?
References
Please give the attached reference form to twopeople (not relations) who will give you a personal reference. Include these references when you submit your application. Your application will not be considered complete without the inclusion of two references.
If you have attended a counselling course, then one reference should be from your course tutor and the other can be an employer or character reference and should have known you for at least two years. If a referee is a Place2Be tutor/staff member, it is your responsibility to ask them that they provide this reference.
If you have lived in the UK for less than two years, we will accept one overseas reference from someone who has known you for more thantwo years.
Disclosure of convictions
Following successful completion of the course, you will have a voluntary placement that will involve access to children. This placement is exempt from the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986 and therefore you must disclose all previous criminal convictions, bindovers and cautions. You must complete this section and list any convictions that you have. If you do not have any convictions then please state ‘No’. We will have to return your application form to you if this section is not completed.
Declaration
Please read the declaration and then sign and date your application. If emailing your application, please type your name (you will be asked to sign your application at interview).
Ensuring equality in recruitment and selection for paid and unpaid positions
AtPlace2Be, we actively monitor our selection process to assess whether we are achieving equality of opportunity. In order to help us with this, we ask you to complete this form voluntarily. We are still able to consider your application if you choose not to complete this form.
Making a lifetime of difference to children in schoolsPlace2Be, 13/14 Angel Gate, 326 City Road, LondonEC1V 2PT
Tel: 020 7923 5500 Email:
Ensuring equality in recruitment and selection for paid, unpaid positions and training courses.
The Equality and Human Rights Commission strongly recommend that monitoring is effectively carried out and Place2Be fully supports this.
Place2Be aims to ensure that no job applicant or worker receives less favourable treatment on the grounds of race, colour, gender orientation, nationality, religion, ethnic or national origin, age, gender, gender reassignment or marital status, sexual orientation or disability. Selection criteria and procedures are regularly reviewed to ensure that individuals are treated on the basis of their relevant merits and abilities. All workers will be given equal opportunity and access to training to enable them to progress both within and outside the organisation. This organisation is committed to a programme of action to make this policy effective and will bring it to the attention of all workers.
In order to enable us to successfully monitor and assess whether equality of opportunity is being achieved, please complete this form. Any information on inputted on this form will be treated as confidential.
Rehabilitation of Offenders Act 1974. As Place2Be meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974, applicants offered employment/placement will be subject to a criminal record check from the Criminal Records Bureau before appointment is confirmed. This will include details of cautions, reprimands or final warnings as well as convictions.
Completing this form is voluntary. However, it will enable us to carry out our monitoring policy effectively. The information will be separated from your evaluation form as soon as it is received. It will not be passed on to anyone involved in short-listing or appointment to a further course.
------
1. Are you?□ Male□ Female
------
2. Are you?
1
□ <20
□ 21-24
□ 25-29
□ 30-34
□35-39
□ 40-44
□ 45-49
□ 50-54
□ 55-59
□ 60+
□ would prefer not to say
1
------
The Disability DiscriminationAct 1995 defines a disabled person as someone with a physical or mental illness or impairment which has a substantial and longterm adverse effect on his or her ability to carry out daytoday activities.
4. Do you consider yourself to have a disability? □ Yes □ No
If Yes, Please provide details:
------
5. What is your ethnic group?
Please choose one section from (a) to (e) and then put a cross or tick in the appropriate box to indicate your cultural background (as recommended by the Equality and Human Rights Commission).
(a) White□ British
□ English
□ Scottish
□ Welsh
□ Irish
□Any other White background, please state: / (b) Mixed
□ White and Black Caribbean
□ White and Black African
□ White and Asian
□ Any other Mixed background, please state: / (c) Asian or Asian British
□ Indian
□ Pakistani
□ Bangladeshi
□ Any other Asian background, please state:
(d) Black or Black British
□ Caribbean
□ African
□ Any other Black background, please state: / (e) Chinese or Chinese British or other ethnic group
□ Chinese
□ Any other background, please state:
6. What is your religion?
1
Christianity□
Buddhism□
Hinduism□
Islam□
Jahovah’s Witness□
Atheist□
Prefer not to say□
1
------
7. Are you a parent?□ Yes□ No
------
Thank you for your time in filling in this information.
1