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TCS Counsellor Register

TCS is always interested in receiving applications from Counsellors interested in working with us. To register your details with us, fill in the following form and press Submit.

Personal Details

Name:

Address:

Date of Birth:

Male: Female:

Home Tel. No.:

Mobile Tel. No.:

Email Address:

Preferred Means of Contact:

Professional Details

Qualifications:

Professional Bodies (include member no):

Name of Insurer (Professional Indemnity Insurance)

Insurance Policy Number

Insurer Address

Insurer Phone Number

Counselling Premises (if appropriate)

Premises 1:

Address (including postcode):

Is there disabled access? Yes: No:

Premises 2:

Address (including postcode):

Is there disabled access? Yes: No:

Supervision Details

Name of Supervisor:

Supervisor's Qualification:

Address of Supervisor

Supervisor's Phone Number

Frequency of Meetings

Employment Details

Outline Current Employment Details:

Outline Previous Experience:

Referees Details (two required)

Name of First Referee:

Address of First Referee:

Phone Number of First Referee:

Name of Second Referee:

Address of Second Referee:

Phone Number of Second Referee:

This information will be stored on our computer database unless you indicate that you do not wish this to happen by ticking this box