Trainee Application Form

Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City County Post Code

Date of Birth(Required)

Home Telephone Number

Mobile Telephone Number

Your Email

Proof of ID(Required)

Driving License

Passport

Proof of ID File(Required)

Max. file size: 10 MB.

Please upload a scan of your ID proof here

Where did you here about this opportunity?

College Details

College Name and Address (Where you are studying)

College Address Line 2 City County Post Code

Tutor's Name

First Last

Date Course Started

Course Details

Counsellor / Therapist

Do you currently have a counsellor / therapist?(Required)

Yes

No

Counsellor / Therapists Name

First Last

Counsellor / Therapist Contact Number

Counsellor / Therapist Email

Supervision

Do you currently have a supervisor?(Required)

Yes

No

Supervisor's Name

First Last

Supervisor Contact Number

Supervisor Email

Information

Do you have BACP student Membership ?(Required)

Yes

No

BACP Membership File(Required)

Max. file size: 10 MB.

Please upload BACP membership document

Do you have Insurance ?(Required)

Yes

No

Insurance File(Required)

Max. file size: 10 MB.

Please upload Insurance document

Do you have a DBS report ?(Required)

Yes

No

DBS File(Required)

Max. file size: 10 MB.

Please upload DBS document

Do you have a fitness to practice certificate?(Required)

Yes

No

Fitness to practice File(Required)

Max. file size: 10 MB.

Please upload fitness to practice document

Health

Do you have a disability or special needs?

Yes

No

Please provide details about your disability or special needs

Have you any illness, or do you take any medication, that we should be aware for example, epilepsy or asthma? (We ask this question to ensure we know about any support needs you may have when you start volunteering with us and to ensure your safety)

Do you have any allergies?

Yes

No

Please provide details of your allergies

Emergency Contact

Name of Emergency Contact

First Last

Emergency Contact Number

Relationship

Qualifications & Employment

Qualifications (Please provide details of any relevant qualifications, level and awarding body. Use the + button to add more rows.)

Please give details of any jobs you have undertaken where you feel they have provided relevant skills / experience in you undertaking the journey to become and ultimately practice as a counsellor.

References

Please provide details of two referees, who are not related to you. e.g. Employer & colleague

First Referee's Name

First Referee's Address

Street Address Address Line 2 City County Post Code

Phone Number

Email

Relationship

Second Referee's Name

Name

Second Referee's Address

Street Address Address Line 2 City County Post Code

Phone Number

Email

Relationship

I confirm that the details provided are accurate and accept that incorrect, misleading and or incomplete information will affect my application.(Required)

I confirm that my information is accurate and correct.

Signature(Required)

Date(Required)

College Details

Counsellor / Therapist

Supervision

Information

Health

Emergency Contact

Availability

Shaw (Beal Lane, OL2 8PH)

Rochdale (Bury Road, OL11 4EE)

Qualifications & Employment

References

© Copyright Community Counselling Service 2019-2025 All Rights Reserved

Website by U r ban Haze

Terms and Conditions

Cookie Policy

Privacy Policy