Application Form for prospective Practitioners

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Application Form for prospective Practitioners
Name:…………………………………………………………………………………………................
Date of Birth:………………………………………………………………………………….................
Address:………………………………………………………………………………………................
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Tel Landline:……………………………………Mobile:……………………………………................
Email address:………………………………………………………………………………………......
Therapies you practice:………………………………………………………………….....................
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Qualifications: ………………………………………………………………………………................
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Dates and length of courses: ………………………………………………………………................
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Governing body(ies) registered with: …………………………………………………………………
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Insurance with: …………………………………………………………………………………………
What do you understand by the term Social Enterprise?
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Which part of working at The Healing Clinic most interests you?
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How long do you envision working with the Healing Clinic?
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How much do you charge?
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Where have you practised previously?
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For how long?
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Please add anything else you may think is relevant:
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Please enclose a copy of your certificates and your insurance policy.
Thank you for your application!
We will try to reply as soon as possible.
You can fill this form and email it to [email protected]
or mail it at The Healing Clinic, Club Chambers, Museum Street, York, YO1 7DN
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