December 2013

Over 49 years of providing information, education and supporting people affected by drug and alcohol use.

VOLUNTEER COUNSELLOR

APPLICATION FORM

Winners of the Team London Awards 2012

Best Practice in Volunteer Management

for‘Improving Community Safety’

Please return application form to:

Deborah Forster

Blenheim

Cantilever Court

212 Wandsworth Road

SW8 2JU

Tel: 0207 582 2200

Fax: 0207 582 2211

Dear Applicant,

Thank you for your interest in applying to volunteer with Blenheim, we provide support services for drug and alcohol users, families and carers.

Our mission

‘To end dependency by enabling people to change’

We believe in people’s capacity to change

Please complete every section of this form and return to the address as stated on the front sheet.

We will acknowledge the receipt of your application and we will contact you again with an interview date should you be shortlisted.

Once again I would to thank you for your interest in volunteering with Blenheim

Blenheim Volunteer Programme

Blenheim has an award winning VolunteerProgramme;volunteers are at the core of our service delivery.

Criteria for volunteering:

Over 18

Application

Interview

DBS (Disclosure and Barring Service)

2 x references

A non judgemental attitude

Good interpersonal skills

Basic written and verbal skills

Ex-service users are encouraged to apply

All applicants will be looked at on an individual basis

We can offer you practical experience volunteering in one of our community services

You will receive regular support and supervision, reimbursed fares whilst volunteering andhave access to ourunique volunteer trainingprogramme.

Please do not send a CV. Please be sure to read through all of the questions on our application form and answer as thoroughly as you can.

All short-listed applicants will be called in for an interview.Successful applicants will need to attend an Induction Programme before starting their placement.

Volunteer counsellor Application Form

Name:
Address:
Tel: Home:
Tel:
Work:
Mobile:
Email:
Next of Kin:
Address and contact number:

How did you hear about Blenheimand why are you interested in volunteering with Blenheim?

Have you ever accessed any services at Blenheim, if so which services were used and when?

Name of Service: / Date from: / Date to:

Please give details of past or present voluntary work.

Name of organisation: / Date from: / Date to: / List duties:

Please give details of past or present employment.

What is your experience/knowledge/attitude regarding substance misuse?

If you are currently accessing any services for drug or alcohol treatmentyourself, please give details.

Please tell us about anyskills/experience you have regarding mentoring, coaching, counselling, group-work, befriending or information advice and guidance?

Please list any professional qualifications you have

Name of qualification: / Where achieved / When

Are you working towards BACP or UKCP accreditation?

______

Do you have clinical supervision in place? (You will be required to have in place and finance yourself once volunteering at Blenheim)

Please state your current commitments or any changes you may have coming up in the near future.

Do you know anyone who is currently either accessing our services or who works or volunteers with Blenheim CDP?

If accepted what times and days are you available to volunteer?

Days / Monday
9:30 – 5:00pm / Tuesday
9:30-
5:00pm / Wednesday
9:30-
5:00pm / Thursday
9:30-
5:00pm / Friday
9:30-
5:00pm
Times

Tick boroughs you would have a preference to volunteer in

Kensington & Chelsea / Haringey / Uxbridge / Islington / Southwark
Ilford / Lambeth / Bexleyheath / Hammersmith & Fulham / Lewisham

Signed:Date:

Volunteer’s References

Please provide the details of twopeople who we can contact for a reference to support your application. Please note this does NOT include friends or family.

They should be someone who has known you in a professional capacity for at least 6 months, within the last 2 years.

If your are a student counsellor this should be your course tutor and Clinical supervisor. If you are qualified this should be your clinical supervisor an current or previous employer.

Please ask permission from your referee before giving his/her details.

Referee One:

Name/Title:

Full Address:

Email:

Tel:

In what capacity do you know this person and for how long?

Referee Two:

Name/Title:

Full Address:

Email:

Tel:

In what capacity do you know this person and for how long?

Confidential Monitoring Form

Any information provided on this form is anonymous and treated with the strictest confidence.

Gender, please tick:
Male  Female  not specified 
Employment Status, please tick:
Full time work Part time work Full time student  Part time student Registered unemployed  Unwaged not seeking work 
Ethnicity, please tick:
White British  White Irish  White other  Asian or Asian British
Asian or Asian British Bangladeshi  Asian or Asian British Indian
Asian or Asian Pakistani  Asian Other Black British 
Black or Black British Caribbean  Black or Black British African  Black Other Chinese Mixed Other ………………………..
Disability
Under the definition in the 1995 Disability Discrimination Act, do you consider yourself to be disabled? (A physical or mental impairment which has a substantial and long – term adverse effect on the ability to carry out day to day activities).
Please tick: Yes  No 
And give details:

Can you confirm you are over 18 years of age? Yes No

Declaration of Offences Form

Rehabilitation of Offenders Act 1994

Blenheim will not discriminate in its decisions against ex-offenders with criminal records if it is judged that the offence has no relevance to the post(s) applied for.
As the post for which you are applying is exempt from the provisions of the Rehabilitation of Offenders Act you must declare any convictions both spent and unspent. Any information you do disclose will be kept in strict confidence and will be used only in consideration for your suitability for the post.
All candidates should be aware that it is Blenheim policy to apply for disclosures from the Criminal Records Bureau for employees and volunteers. Confirmation in post will be subject to the receipt of a satisfactory Criminal Records Bureau Disclosure.
Please give details below of any cautions, bindovers and criminal offences including any pending convictions, or criminal investigations that you are currently the subject of. If you have no convictions please write none and sign the form. Please enclose this page in a sealed envelope marked ‘Confidential’ with your application form.
Have you ever been convicted of a criminal offence?YesNo
Conviction / Dates / Sentence (please indicate whether this is current or spent)
Are you currently on a Probation Order or in contact with a Probation Officer or other professionals in relation to your conviction?
It would be helpful if you could give us further details on any conviction(s) recorded above:
Continue on a separate sheet if necessary
(Please use A4-sized paper and write on one side only)
Declaration
I certify that, to the best of my knowledge, the information on this form is true and accurate. I understand that if the information I have supplied is false or misleading in any way, it will automatically disqualify me from appointment or me render me liable to instant dismissal without notice.
Signature (type name if sending by e-mail): / Date:

Thank you for completing this application form

Please return application form to:

Deborah Forster

Blenheim

Cantilever Court

212 Wandsworth Road

SW8 2JU

Tel: 0207 582 2200

Fax: 0207 582 2211