Application Form (UOL)

Application Form

Leeds On-Site Position

This position is for on-site work only. You must be in a position to work on-site one day of the week for a minimum of at least 5 hours

Please read our Privacy Link to counsellors’ privacy GDPR information on what we collect, how we use it, and your rights.
NB: Once we receive the completed application form, we will be in touch.

First Name*

Surname*

Business Address Number*

Business address Street Name*

Business Address Town*

Business Address County*

Business Postcode*

Business Telephone Number*

Email Address*

Insurance Certificate*

PDF format only

Accredited with*

Confirm which membership body you are accredited with? BACP/UKCP/NCS. Full accreditation with either BACP, UKCP or NCS (Accredited Professional Registrant) is an essential requirement

Accreditation Number*

Accreditation Expiry Date*

Use dd/mm/yyyy format

Accreditation Certificate*

PDF format only

Current Supervisor"s Name*

Supervisor"s Email*

Hours of Supervision Per Month*

CV*

PDF format only

Modality*

Provide information about the theoretical approach(es) you use when working with a workplace client. Ensure you include Solution Focused Brief Therapy, CBT and Single Session Intervention Model (approx. 200 words)

Describe you experience as a workplace counsellor*

Provide details of your experience as a workplace counsellor.

Describe the challenges that come with workplace counselling*

What specific issues / challenges does a workplace counsellor have to consider when performing their role? How does workplace counselling differ from other types of counselling provision? (approx 250 words)

* required fields

Clients we've worked with