Apply online 1234567891011 Personal DetailsName* First Last Address* Street Address Address Line 2 City Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone Number*Email* RefereesPlease give details of two referees, at least one of whom must have direct experience of working with you in a paid or voluntary capacity. Where possible please do not give details of relatives, partners or friends as a second referee. If you are invited to interview, Referee OneName First Last Position Held and RelationshipOrganisation*Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Telephone number*Are you happy for Crew to contact Referee One in advance of interview?* Yes No Referee TwoName First Last Position Held and RelationshipOrganisation*Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Telephone number*Are you happy for Crew to contact Referee Two in advance of interview?* Yes No Reason for applicationPlease note that CVs or cover letters will not be accepted in place of or in addition to completed application formsPlease state your reasons for applying for this position and briefly explain how it will fit alongside your other commitments:* EducationFurther or Higher Education*College/UniversityQualificationDate acheived Training and CPD*Other relevant training courses or Continuing Professional Development (CPD) attendedQualifications/outcomesDate achieved Membership of professional bodiesProfessional bodyMembership categoryDates Work historyCurrent and previous employment *Most recent first Additional InformationUsing the essential and desirable criteria in the person specification as a guide, please give evidence under each point on how your skills, knowledge and experience meet the criteria for this post. You must demonstrate that you have used the required skills or gained the required experience to meet the criteria and give specific examples. Please use the STAR approach when giving examples: Situation (i.e. where you demonstrated a skill or gained experience) Task (what your responsibilities were) Action (what you did) Result (what the outcome was). It is particularly important you make clear the role you played and how that led directly to the result achieved to evidence your points. Applications will be scored out of a maximum of 5 points for each criterion, and points will not be awarded unless full evidence is given as above. Assertions (saying you have done something or have the skills without giving evidence and specific examples) will not score more than 1 point. Applications in which evidence does not meet the minimum score (1/5) on any one of the essential criteria will not be shortlisted for interview. Please leave the score column blank for short-listing. 1. Previous ExperienceEssential CriteriaMinimum 3 years’ experience of counselling practice*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreTrack record of successful performance management*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreExperience in handling child and adult protection concerns and disclosures*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreDesirable CriteriaExperience of counselling people affected by drug or alcohol useYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreExperience of successfully leading a counselling practice teamYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreExperience of delivering appraisalsYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreExperience of overseeing a budgetYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreExperience of working with volunteersYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreTrack record of successful fundraisingYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreExperience of using the Salesforce, CORE and SMR25Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScore 2. Aptitude/Abilities/SkillsEssential CriteriaAbility to lead, motivate and co-ordinate a team*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreAbility to lead and improve practice according to BACP organisational requirements*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreAble to engage effectively with own case and line management supervision*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreAble to build positive therapeutic relationships with clients affected by stimulant drug use*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreAble to balance competing priorities and a full and complex workload, including a small counselling caseload*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreAbility to produce accurate, clear reports within specified deadlines*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreICT skills including advanced MS word processing and use of databases to enter data and retrieve reports*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScore 3. Education/KnowledgeEssential CriteriaRegistered membership of BACP, COSCA or other relevant body*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreSound understanding of BACP guidelines and ethical framework and willingness to work according to these*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScorePost-Graduate or Diploma level qualification in counselling or psychotherapy*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreContinued Professional Development Training in counselling*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreA good understanding of child and adult protection principles and procedures*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreWillingness to learn about psychostimulant drugs and their effects*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreDesirable CriteriaAccredited counsellor with BACP/COSCA or equivalent, or willing to work towards accreditationYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreContinued Professional Development training on stimulant drugs and their effectsYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreTraining in use of the DAISy databaseYour evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScore 4. Attitudes/personalityEssential CriteriaWilling to work according to Crew’s organisational ethos of working with people to effect change*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScoreAbility to work flexible hours including providing an evening counselling session until 7PM with a time off in lieu (TOIL) system*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScore 5. OtherAbility to work flexible hours including providing an evening counselling session until 7PM with a time off in lieu (TOIL) system*Your evidence of how you meet the criteria using the STAR approach:This field is hidden when viewing the formScore Other informationMembership of the Protecting Vulnerable Groups Scheme is required for this post, which is recognized as regulated work. It is an offence to apply for regulated work if you are barred from working with children and protected adults. Date when you could begin to work:* DD slash MM slash YYYY Do you have a right to accept paid work in this country?* Yes No Please state how you heard about this vacancy:*Declaration*In accordance with the Data Protection Act 1998, I give my consent for the information in this form to be processed in accordance with the Crew2000 policy for the purposes of selection of contractors and/or volunteers for services. I understand that if I am engaged to provide services, it will be stored for six months and then destroyed. I certify that the information given on this form is correct to the best of my knowledge. I understand that, should any false statements be made, this may lead to termination of any contract signed. I agree to the policy.Signature*Date* DD slash MM slash YYYY NameThis field is for validation purposes and should be left unchanged.