Expression of Interest

Register Your Interest
YOUR DETAILS
First Name: *
Surname: *
Address:
Telephone:
Email: *
YOUR QUALIFICATIONS AND EXPERIENCE
Are you a qualified: *

Counsellor Registered Psychologist Clinical Psychologist Clinical Psychologist Registrar Provisional Psychologist
Do you have a current Australian professional industry membership? If yes, please state your organisation and level of membership. *
Do you have a current police clearance? *

Yes No
Do you have a current Working with Children Check? *

Yes No
Do you have a current Senior First Aid Certificate?

Yes No
Do you have experience working with people who have a disability? *

Yes No
Have you completed any disability awareness training? *

Yes No
Please select which client types you would like to work with. *

Individuals Couples Families Children (under 13 years) Adolescents (13-18 years)
Please select which areas you have experience working in and are willing to work in. *

Addictions Anger Management Anxiety CBT Depression Domestic Violence Employee Assistance Programs Eating Disorder Family Therapy Grief and Loss Group Work Hypnotherapy Parenting Personal Issues Pre & Post Natal Issues Sex Therapy Sexual Abuse Trauma
YOUR AVAILABILITY
Preferred days: *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Preferred hours: *

Mornings Afternoons After Hours Weekends
Do you currently have your own private practice? *

Yes No
If you have your own private practice and are able to accept referrals, please state the location/s of your practice.
If you have your own private practice, do you have accessible facilities to receive clients with a disability?
If you are thinking of starting your own private practice, would you like to find out about our business incubation program for new counsellors? *

Yes No
Other relevant information
Should be Empty: