Group Supervisor Application

If you would like to apply to be a Group Supervisor please complete the form below and we will be in touch to discuss your application.

First name(s)

Last name

Maiden Name (if applicable)

Photo

Date of Birth

Phone

Street Address

Town/City

Postcode

Do you have any additional needs?

Employment (Most recent first)

Please provide details of employment covering Dates employed, Organisation, Role/Activity and Reason for Leaving.

Employment Details

Please mention any gaps in your employment history and reason/s for this.

Qualifications (education/professional) (Most recent first)

Please include Dates, Name of College and Accrediting University along with Qualification gained.

Qualifications

Counselling Training

Please indicate the name of your training institution and its awarding body e.g CPCAB, BACP or UKCP and the approximate duration.

Formal Counselling Qualifications (most recent first)

Please include Title of Course, Dates/Duration, Qualifications and the Name of College/Training Provider.

Qualifications

Total hours

Brief outline of your Supervision Course Curriculum

Other Substantial Counselling Training Undertaken

Please include Title of Course, Dates/Duration, Qualifications and the Name of College/Training Provider.

Qualifications

Counselling/Supervision Agency Experience Details

As a Counsellor

As a Supervisor

Supporting Statement (for additional page please upload file)

In this section, please give any additional information to support your reason for your interest in becoming a group supervisor and include any strengths or interests you have to bring for the benefit of Youthline.

Statement details

Additional page

References

Please give the name, position, postal address and email address of two people to whom reference can be made. One should be personal (not a relative) and one professional.

YouthLine takes up references for all applicants.

Reference 1 Personal

Reference 2 Professional

Health Declaration: Do you have, or have had, any medical condition of which we, as a responsible voluntary organisation, would need to be aware?

Yes

Declaration

You are required to sign the declaration below certifying that all the information you have provided is accurate.
YouthLine will check the details you have provided.
Providing incorrect information or deliberately concealing any relevant facts may result in disqualification from the selection process or, where discovery is made after an appointment, in summary dismissal.

Youthline is committed to safeguarding and promoting the welfare of children, and expects its entire staff and volunteers to share this commitment.

I have read and understood the Youthline Data Protection Statement and Privacy notice found on our website http://www.youthlineuk.com/get-involved/

I declare the information on this form is correct and I have omitted nothing that, to the best of my knowledge, might affect this application.

Print Name

Date

Signature

Before submitting your application please make sure to upload relevant Qualification / Training certificates.

Certificates