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Accredited Partner Programme Application Form

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Application form for Accredited Partner Programme

Please complete as much of this form as possible and provide full contact details — including email addresses — for two
referees. Any queries will be discussed with you at the onboarding meeting. Please use a black font or black ink as appropriate.

On boarding checklist requirements to be provided to Steps Together as part of this application:

  • Two references (one professional, one character)
  • Confirmation of professional registration
  • Most up-to-date CV / résumé
  • Services price list
  • Social media handles
  • Most up-to-date DBS certificate
  • Evidence of no restrictions on practice
  • Confirmation of personal insurance
  • Professional bio
  • Headshot / profile photo

    [custom_collapsible collapsible_title="" collapsible_text="" tag="h2"] [custom_collapsible_item title_item="1. PERSONAL DETAILS" tag="h3" id="item-1"]

    [/custom_collapsible_item] [custom_collapsible_item title_item="2. Professional membership or accreditation" tag="h3" id="item-2"]

    Membership / Accreditation body

    From

    To

    Notes

    [/custom_collapsible_item] [custom_collapsible_item title_item="3. Present Appointment (or most recent)" tag="h3" id="item-3"]

    [/custom_collapsible_item] [custom_collapsible_item title_item="4. Professional development" tag="h3" id="item-4"]

    a. Please provide details of qualifications relevant to this application and indicate any awards earned.

    Qualification

    Provider

    Duration

    Dates

    Awards (if any)

    [/custom_collapsible_item] [custom_collapsible_item title_item="5. Therapy only" tag="h3" id="item-5"]

    Please tick all boxes relevant to your area of expertise.

    [/custom_collapsible_item] [custom_collapsible_item title_item="6. clinical only" tag="h3" id="item-6"]

    Please provide areas of expertise for assessment and diagnosis

    [/custom_collapsible_item] [custom_collapsible_item title_item="7. Bio" tag="h3" id="item-7"]

    Please provide a professional bio to be used as an accredited partner on our website

    [/custom_collapsible_item] [custom_collapsible_item title_item="8. PHOTO/ HEADSHOT" tag="h3" id="item-8"]

    If you are happy for us to do so, please provide a photo/ headshot. This image will be used on our Accredited Partner Outpatient Directory

    [mfile headimage filetypes:jpg|jpeg|png|gif|webp class:upload-image]

    [/custom_collapsible_item] [custom_collapsible_item title_item="9. SERVICE PRICE LIST" tag="h3" id="item-9"]

    Please provide a price list for your services

    [/custom_collapsible_item] [custom_collapsible_item title_item="10. PROMOTION AND MARKETING" tag="h3" id="item-10"]

    Please provide your social media handles

    a. Declaration by Applicant

    As this post is classified as having substantial access to vulnerable adults and possibly children, appointment will be subject to a police check of previous criminal convictions. Disclosure will only be required, following interview if it is considered that you are the most suitable candidate for the post.

    Do you have enhanced DBS clearance?

    [/custom_collapsible_item] [custom_collapsible_item title_item="11. Please provide a copy of your current DBS check" tag="h3" id="item-11"]


    I declare that the information I have given on this form is correct and I understand that failure to complete the form fully and accurately could result in an incorrect assessment of salary, and / or exclusion from short listing, or may, in the event of employment, result in disciplinary action or dismissal.

    [/custom_collapsible_item] [custom_collapsible_item title_item="12. REFERENCES" tag="h3" id="item-12"]

    N.B.     References are to be provided by yourself. Please provide two references on return of the Accredited Partner Programme application form.

    [/custom_collapsible_item] [custom_collapsible_item title_item="13. THE WELFARE, PROTECTION AND SAFETY OF CHILDREN AND VULNERABLE ADULTS" tag="h3" id="item-13"]

    Steps together is committed to safeguarding and promoting the welfare of our clients and visitors. Candidates should expect us to seek to clarify any anomalies or discrepancies in the information provided by them or arising from their references. The interview process will explore candidates’ suitability for working with children and their previous experience in such roles.

    [/custom_collapsible_item]

    [custom_collapsible_item title_item="14. ADULT AND CHILD SAFEGUARDING" tag="h3" id="item-14"]

    Steps Together has a statutory obligation to safeguard and promote the welfare of its clients and visitors. Accordingly, we require all new appointees to answer the following question. Has your name ever been on one of the two barred lists created as a result of the Safeguarding Vulnerable Group Acts 2006.

    [/custom_collapsible_item] [custom_collapsible_item title_item="15. REHABILITATION OF OFFENDERS" tag="h3" id="item-15"]


    The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers , and cannot be taken into account.  Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013).


    Please submit information in confidence, enclosing details in a separate sealed envelope. Failure to declare a conviction may disqualify you from appointment or result in summary dismissal if a discrepancy comes to light.

    I hereby certify that the statements on this form are correct and that no material information is omitted.

    [/custom_collapsible_item]

    [/custom_collapsible]

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