Relate London South East Application Form - Confidential

RELATE LONDON SOUTH EAST APPLICATION FORM - CONFIDENTIAL

Application for the post of: Adult Relationship Counsellor
(please tick as appropriate)Specialisms:
[ ] FamilyCounselling
[ ] Psychosexual Therapy (PST)
[ ] Children (5 to 10 years) Counselling
[ ] Young People (11 – 18 years) Counselling
Location (London Borough):
(please tick the boroughs you would like to work in ) [ ] Bromley [ ] Croydon [ ] Greenwich
[ ] Lambeth [ ] Lewisham [ ] Merton
[ ] Southwark [ ] Sutton
If you are interested in working from your own premises please tick this box [ ]
If you are interested in working from your own home please tick this box [ ]
Number of appointments per week you would like to offer:
(please tick as appropriate)
[ ] 6 appointments [ ] 7 – 12appointments [ ] more than 12
You are not committed at this stage – this is just to give us a broad indication of your thinking

When completing this application form, please

-completeall sections as fully as possible

-we will only consider applicants that have completed this form in full

-email your completed application to:

PERSONAL DETAILS
First name:Family Name:
Address:
Postcode:
Telephone:Mobile
Email:

EDUCATION/QUALIFICATIONS AND TRAINING

Please include all relevant qualifications obtained and other training courses attended, listing the most recent first.
School/College/University / Dates attended
From-To / Qualifications/Training and Grades

PRESENT OR MOST RECENT OCCUPATION

Organisation / Job title / Dates (mm/yy)
FromTo / Salary/ hourly rate
Brief description of your role (and, if applicable, your main reason for leaving):
PREVIOUS OCCUPATIONS (most recent first)
Organisation / Job title / Dates (mm/yy)
FromTo / Reason for leaving

REHABILITATION OF OFFENDERS’ ACT, 1974

Have you been convicted of a criminal offence (other than “spent” convictions under the 1974 Act)?

YES□NO □

If “Yes,” please give details: ………………………………………………………………………

………………………………………………………………………………………………………...

EXPERIENCE AND SKILLS

Before completing, this section please read the enclosed Job Description and Person Specification carefully. Please demonstrate your suitability for this position and how you meet the criteria within the Person Specification by giving relevant details of your experience, skills, and knowledge gained in employment, voluntary work, or elsewhere.
REFERENCES (In block capitals or type please)
Please give the names and contact details of two referees. One referee should be your present or most recent employer, if possible.
Name:Name:
Position/relationship to you:Position/relationship to you:
Address:Address:
Postcode:Postcode:
Email:Email:
Tel No: Tel No:
If your application is shortlisted, can we contact your referees prior to interview?
YES□NO □YES□NO □

GENERAL

Interviews will be held with the Chief Executive and a supervisor on a Tuesday or a Wednesday. Please let us know your availability on these days.
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Do you have any particular accessibility requirements for interview? If so, please specify
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If you were appointed, when would you be available to start work?
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DECLARATION
I wish to apply for the above position. I confirm that to the best of my knowledge the information given above is true and accurate.
Signed ______Date ______