Specialist Services for Survivors of Sexual and Domestic Abuse

APPLICATION FOR ASSOCIATE COUNSELLOR

Please complete this application form. We do not accept CV’s. The application should be completed in black ink or type.

  1. APPLICATION FOR THE POST OF VOLUNTEER:

NAME:
ADDRESS:
EMAIL:
Unless you advise otherwise we will contact you via email. / TELEPHONE NUMBER:
(that PARCS can contact you in office hours)
  1. EDUCATION (including further education – Polytechnics, University. Also include any part-time courses. Start with earliest and continue on separate sheet if required)

SCHOOLS/COLLEGES ETC ATTENDED / FROM / TO / EXAMINATIONS PASSED
(inc. date and level) / GRADE
  1. PARCS intends to provide the opportunity to work with up to three clients on a weekly basis and fortnightly supervision. Additional training is provided throughout the year at weekends. Please indicate below the times you are available to undertake counselling.

  1. CURRENT WORK UNDERTAKEN (please include any voluntary work)

From / Employer(incl name and address) / Position held
  1. PREVIOUS EMPLOYMENT, including volunteering (start with earliest and please explain any gaps in employment history)

From / To / Employer / Position Held
  1. EXPERIENCE – Please summarise some information about yourself in support of your application (i.e. why you want to be an Associate Counsellorbeing considered for a volunteer role).Please include any experience you have of face-to-face counselling giving details of the work undertaken, how many hours completed and the location of the counselling (lack of counselling experience will not preclude you from becoming a volunteer).

  1. What qualities, skills and/or life experiences will you bring to PARCS.

  1. HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE? YES / NO
(This position is exempt from Rehabilitation of Offenders Act 1974 as it involves access to children.)
YOU WILL BE REQUIRED TO COMPLETE AN ENHANCED CRB APPLICATION
  1. PLEASE TELL US IF THERE ARE ANY DATES WHEN YOU WILL NOT BE AVAILABLE FOR INTERVIEW

  1. IF YOU HAVE A DISABILITY PLEASE TELL US ABOUT ANY ADJUSTMENTS WE MAY NEED TO MAKE TO ASSIST YOU AT INTERVIEW

  1. NAME AND ADDRESS OF TWO REFEREES WHO ARE NOT RELATIVES ANDIF POSSIBLE YOUR CURRENT EMPLOYER(If you are studying or have studied for a counselling certificate please give details of a course tutor/supervisor as a referee).

Name:
Email:
Tel No: / Name:
Email:
Tel No:
Do you agree to referees being approached prior to interview?
1. Yes / No
2. Yes / No
  1. I wish to apply for this post. I certify that all the foregoing information is correct to the best of my knowledge and belief. I understand that if any of the information provided by me in this application form proves to be incorrect in any way, action may be taken to terminate this appointment.
Signature...... Date......
Upon completion return to:
Becs Feek
Portsmouth Abuse and Rape Counselling Service
P O Box 3
Portsmouth
Hants
OR
Email –(returning this form by email will constitute that you have agreed to Section 12.)

PARCS consider that it is not appropriate for a recent client of the charity to apply for a volunteer post until 6 years have elapsed since the last contact with the service. Failure to adhere to this policy will be lead to a termination of the recruitment process or, if recruited, action will be taken to end the volunteering role.

PARCS cannot accept volunteers who have a past or current relationship with a service user, volunteer or member of staff. For further details please contact Kim Hosier on 023 9266 9514.

Portsmouth Abuse and Rape Counselling Service

Equal Opportunities Monitoring Form

Portsmouth Abuse and Rape Counselling Service (PARCS) is committed to a policy of equality and the elimination of discrimination in all aspects of its work. To ensure that the aims of the policy are being achieved PARCS needs to record certain personal details about prospective employees/volunteers. We hope that, seen in the context of equal opportunities, these questions will give not cause for offence.

This information will be used solely for monitoring purposes, and will not be taken into account when assessing your application.

(Please indicate as appropriate)

Gender:
Male
Female / Age:13-16
17-25
26-35
36-45
46-55
56-65
66+

Sexual Orientation: ______

(E.g. gay, lesbian, bi, straight)

Religion: ______

(Please indicate as appropriate)

Ethnic Origin:
Asian/ Asian British Bangladeshi
Asian/ Asian British Indian
Asian/ Asian British Other
Asian/ Asian British Pakistani
Black/ Black British African
Black/ Black British Caribbean
Black/ Black British Other
Chinese / Mixed Other
Mixed White and Asian
Mixed White and Black African
Mixed White and Black Caribbean
White British
White Irish
White Other
Other Ethnic Group
(Please State)______

Are you registered disabled?Yes

No

Thank you for your co-operation

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