Please include here relevant details of ALL counselling training courses that you have attended or are attending. Please start with the most recent.
We believe that experience as a client in personal counselling/therapy is essential in developing individual competence as a practitioner. The reasons for this are (a) to have first-hand experience and understanding of what it means to be a client and (b) to ensure as much as possible that the practitioner does not bring his/her own limitations and difficulties to the therapeutic relationship. For these reasons we require that you have had or are currently undertaking personal therapy
At least 2 references will be sought using the information provided at sections 3 & 4 above. Please also provide details of personal referees here. Referees must be over 18 and not be family members or relatives. Please note that 'Self-supplied’, ‘to whom it may concern’ and verbal references will not be accepted.
The Confidential Declaration Form must be completed by those wishing to work with children or vulnerable adults or in a position of trust.
This form is strictly confidential and, except under compulsion of law, will be seen only by those responsible for the appointment and, when appropriate, the Diocesan Safeguarding Adviser or someone in a similar position. All forms will be kept securely under the terms of the Data Protection Act 1998.
Note: Declare all convictions, cautions, warnings or reprimands however old or whether you are at present under investigation by the police.
Posts where the person is working or coming into regular contact with children or vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974. Convictions obtained abroad must be declared as well as those from the UK.
Note: Declare all convictions, cautions, warnings or reprimands however old or whether you are at present under investigation by the police.
Posts where the person is working or coming into regular contact with children or vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974. Convictions obtained abroad must be declared as well as those from the UK.
Note: Declare all convictions, cautions, warnings or reprimands however old or whether you are at present under investigation by the police.
Posts where the person is working or coming into regular contact with children or vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974. Convictions obtained abroad must be declared as well as those from the UK.
Note: Declare all convictions, cautions, warnings or reprimands however old or whether you are at present under investigation by the police.
Posts where the person is working or coming into regular contact with children or vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974. Convictions obtained abroad must be declared as well as those from the UK.
Note: Declare all convictions, cautions, warnings or reprimands however old or whether you are at present under investigation by the police.
Posts where the person is working or coming into regular contact with children or vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974. Convictions obtained abroad must be declared as well as those from the UK.
Note: Make any statement you wish regarding any incident you wish to declare.
Please give details, including the date(s) and nature of the conduct, or alleged conduct, and whether you were dismissed, disciplined, moved to other work or resigned from any paid or voluntary work as a result.
Note: Declare any complaints or allegations made against you, however long ago, that you have significantly harmed a child, young person or vulnerable adult. Any allegation or complaint investigated by the police, Children’s Services, an employer or voluntary body must be declared. Checks will be made with the relevant authorities.
1 Certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.
2 Significant harm involves serious ill-treatment of any kind including neglect, physical, emotional or sexual abuse, or impairment of physical or mental health development. It will also include matters such as a sexual relationship with a young person or adult for whom you had pastoral responsibility or were in a position of trust.
Note: Declare any complaints or allegations made against you, however long ago, that you have significantly harmed a child, young person or adult who is vulnerable. Any allegation or complaint investigated by the police, Children’s Services, an employer, voluntary body or other body for which you worked must be declared. Checks will be made with the relevant authorities.
Note: All these matters shall be checked with the relevant authorities Before an appointment can be made applicants who will have substantial contact with children and / or adults experiencing, or at risk of abuse or neglect in their roles will be required to obtain an enhanced criminal record check (with or without a barred list check (as appropriate)) from the Disclosure and Barring Service.
All information declared on this form will be carefully assessed to decide whether it is relevant to the post applied for and will only be used for the purpose of safeguarding children, young people and / or adults experiencing, or at risk of abuse or neglect.
Please note that the existence of a criminal record will not necessarily prevent a person from being appointed, it is only if the nature of any matters revealed may be considered to place a child and / or an adult experiencing, or at risk of abuse or neglect at risk.
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