Making a lifetime of difference to children in schools
Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT
Tel: 020 7923 5500
Email: enquiries@place2be.org.uk
Application Form
Level 3 Certificate in Counselling Skills for Working
with Children (Foundation)
Please refer to the ‘Guidance notes’ before completing your application. Complete this
form using black ink or type. If there is not enough space in any section, please attach
further sheets and mark them clearly with your name.
Which Level 3 Certificate Course are you applying for?
Location
Start Date
Which Taster Day: Counselling Children Workshop did you attend?
Location
Date
Personal details
First/Given Name(s)
Surname/Family Name
Previous surname
(if changed)
Title (e.g. Mr Mrs Miss Mrs
etc.)
Preferred name/
Known as
Address
Post code
Telephone number
Mobile number
Email address
How did you hear about this course?
This may be from an advert (please state which
publication/place), a website (please state which), word
of mouth (please give details) or other (please give
details).
When you are ready to take up your counselling placement with Place2Be we would like to share the
information on this form with our Human Resources Department
Do we have your permission to do this? Yes / No
Please return your completed application form and references to: Place2Be Training, 13/14 Angel Gate, 326 City
Road, London, EC1V 2PT. If you have any queries regarding your application please contact Place2Be Training on
020 7923 5535 or via email to qualify@theplace2be.org.uk
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
Relevant experience
Please tell us your experience of looking after children below, remembering to tell us the
ages of the children concerned.
Context
Brief description of duties
Dates
(paid employment,
volunteering, parent or carer –
starting with the most recent)
(please remember to state whether
any work was paid or voluntary)
(from - to)
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
Education and training
Training institution
(most recent first)
Course and type of
qualification
Dates
(from - to)
(if applicable)
Counselling or therapy training
Please note, you don’t need to have had any previous counselling or therapy training to
apply for this course, but if you have it would be helpful for us to know about it.
Training institution
(most recent first)
Course and type of
qualification
(if applicable)
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
Dates
(from - to)
Supporting statement
Please answer all the supporting statement questions provided in the ‘Guidance
notes’.
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
References
Please give the attached reference form to two people (not relations) who will give you a
personal reference. Include these references when you submit your application. Your
application will not be considered complete without the inclusion of two references.
Please provide the details of your two referees below, refer to the ‘Guidance notes’ provided
for more information.
First referee
Full Name
Relationship
(e.g. employer,
tutor, friend)
Address
Telephone
Email address
Second referee
Full Name
Relationship
(e.g. employer,
tutor, friend)
Address
Telephone
Email address
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
Disclosure of convictions
As the voluntary placement will involve access to children, the placement is exempt from
the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986 and you
will be required to undertake an Enhanced Disclosure from the Criminal Records Bureau
CRB which will show all records. Please contact us if you would like further information.
Any placement offered would be conditional on the receipt of an enhanced CRB which
satisfies the criteria of Place2Be. A copy of the CRB Code of Practice is available on the
CRB website.
* Do you have connections in your personal life with any individual (relative,
household member or friend) who could present a risk to children or who has been
convicted of a criminal offence which would deem them unsuitable to work with
children? (Please answer Yes or No)
* Have you, as an adult, had involvement with a local authority, in relation to care
proceedings or child protection proceedings in your family?
(Please answer Yes or No)
* Have you ever been arrested, cautioned for or convicted of a criminal offence or
other offence which would show in a CRB enhanced disclosure? (Please answer Yes
or No)
If YES, please give details and an explanation of the offence and sentence or penalty
imposed (including suspended sentences, warnings etc) in a separate file marked
‘confidential’ including an explanation of how you have consequently demonstrated
you are a suitable person to work directly with children.
The Disability Discrimination Act
What adjustments if any would be needed to assist you in carrying out this course, if
accepted?
Would any adjustments need to be made to the interview process to assist you in
your application?
YES/NO
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
If yes, please provide details:
Declaration
I declare that the information I have provided on this form is true and complete and that all
questions relating to me have been accurately and fully answered.
I understand that if it is subsequently discovered that any statement is false or misleading,
or that I have concealed any relevant facts, my placement will be withdrawn.
Signed
Date
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
Guidance notes
These notes talk you through the kind of information needed to complete each section of
the form. If you have any questions, please call us on 0207 923 5535.
Taster Day: Counselling Children Workshop
To apply for the Level 3 Certificate Course you need to first attend a Taster Day. To book
on the next Taster Day please refer to our training website
www.theplace2be.org.uk/p2btraining/ or contact the Professional Qualifications Team on
0207 923 5558 or email qualify@theplace2be.org.uk.
Once you have attended a Taster Day the tutors will be able to assess which will be the
most appropriate course for you. If you are invited to apply for the Level 3 Certificate
Course you will need to complete this application form and provide two references.
Successful applicants will then be invited for a one-to-one interview.
Following a successful interview we will endeavour to offer you a place on the Level 3
Certificate Course of your choice. If your first choice is not available we will offer you a place
on the next course running.
Personal details
Please complete all sections in full.
Relevant experience
Please outline your experience of looking after children as a parent, guardian or carer and
in any paid or voluntary post. Relevant experience may include helping at a local children’s
group (e.g. at a playgroup or at a place of worship), working with Cubs or Brownies, etc.
To apply for the Level 3 Certificate Course, you need to have at least one year's experience
working with, caring for or parenting primary-aged children.
Education and training
Please list any education or training that you have completed. You can also include any
relevant short courses (lasting one day or more) where the main topic was looking after
children.
Counselling or therapy training
Please note, you don’t need to have had any previous counselling or therapy training to
apply for this course. But if you have, please use the space to tell us about it.
Supporting statement
Please consider the following questions and give brief answers to all of them:

Why do you want to undertake this training and what do you hope to gain from the
course? Why do you feel that now is the right time to begin?

What skills and knowledge do you have that you have already used when looking
after children?

In what way does your own experience of childhood influence the way that you look
after children?
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.

What do you imagine it will be like for you as an adult to be in training again and
learning in a group with others?

Describe some activities that you engage in which promote personal development
and self awareness and outline how this benefits you?
References
Please give the attached reference form to two people (not relations) who will give you a
personal reference. Include these references when you submit your application. Your
application will not be considered complete without the inclusion of two references.
If you have attended a counselling course, then one reference should be from your course
tutor and the other can be an employer or character reference and should have known you
for at least two years.
If you have lived in the UK for less than two years, we will accept one overseas reference
from someone who has known you for more than two years.
Disclosure of convictions
Following successful completion of the course, you will have a voluntary placement that will
involve access to children. This placement is exempt from the Rehabilitation of Offenders
Act 1974 (Exceptions) (Amendment) Order 1986 and therefore you must disclose all
previous criminal convictions, bind-overs and cautions. You must complete this section and
list any convictions that you have. If you do not have any convictions then please state ‘No’.
We will have to return your application form to you if this section is not completed.
Declaration
Please read the declaration and then sign and date your application. If emailing your
application, please type your name (you will be asked to sign your application at interview).
Ensuring equality in recruitment and selection for paid and unpaid
positions
At Place2Be, we actively monitor our selection process to assess whether we are achieving
equality of opportunity. In order to help us with this, we ask you to complete this form
voluntarily. We are still able to consider your application if you choose not to complete this
form.
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
Ensuring equality in recruitment and selection
for paid, unpaid positions and training
courses
The Equality and Human Rights Commission strongly recommend that monitoring is
effectively carried out and The Place2Be fully supports this.
Place2Be aims to ensure that no job applicant or worker receives less favourable treatment
on the grounds of race, colour, gender orientation, nationality, religion, ethnic or national
origin, age, gender, gender reassignment or marital status, sexual orientation or disability.
Selection criteria and procedures are regularly reviewed to ensure that individuals are
treated on the basis of their relevant merits and abilities. All workers will be given equal
opportunity and access to training to enable them to progress both within and outside the
organisation. This organisation is committed to a programme of action to make this policy
effective and will bring it to the attention of all workers.
In order to enable us to successfully monitor and assess whether equality of opportunity is
being achieved, please complete this form and return it with your application form.
Rehabilitation of Offenders Act 1974. As The Place2Be meets the requirements in
respect of exempted questions under the Rehabilitation of Offenders Act 1974, applicants
offered employment/placement will be subject to a criminal record check from the Criminal
Records Bureau before appointment is confirmed. This will include details of cautions,
reprimands or final warnings as well as convictions.
Completing this form is voluntary. However, it will enable us to carry out our
monitoring policy effectively. The information will be separated from your
application as soon as it is received. It will not be passed on to anyone involved in
short-listing or appointment to this course.
______________________________________________________________________
Course applied for__________________________________________________
Are you?
□ Male
□ Female
Are you?
□ <20
□ 21-24
□ 25-29
□ 30-34
□ 35-39
□ 40-44
□ 45-49
□ 50-54
□ 55-59
□ 60+
□ would prefer not to say
______________________________________________________________________
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.
The Disability Discrimination Act 1995 defines a disabled person as someone with a
physical or mental illness or impairment which has a substantial and long-term adverse
effect on his or her ability to carry out day-to-day activities.
Do you consider yourself to have a disability which may affect your employment/placement?
If Yes, Please provide details:
What is your ethnic group?
Please choose one section from (a) to (e) and then put a cross or tick in the appropriate box
to indicate your cultural background (as recommended by the Commission for Racial
Equality).
(a) White
(d) Black or Black British
□ British
□ Caribbean
□ English
□ African
□ Scottish
□ Any other Black
□ Welsh
background, please state
□ Irish
______________
□ Any other White background, please state
_______________________
(b) Mixed
(e) Chinese or Chinese
British or other ethnic
group
□ White and Black Caribbean
□ White and Black African
□ Chinese
□ White and Asian
□Any other, please state
□ Any other Mixed background,
___________________
_______________________
(c) Asian or Asian British
□ Indian
□ Pakistani
□ Bangladeshi
□ Any other Asian background, please state
www.place2be.org.uk
Registered office address: The Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 2876150.