Clinical Placement Application

Application

This secure area is for those applying for a clinical placement with Cork Counselling Clinic.

ACCESS PASSWORD

If you have not received the access password, contact:
info@corkcounsellingclinic.ie

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Clinical Placement Application

Access granted. The full placement application form is below.

Therapist Placement Application

Complete this form to apply for a student placement. When you submit, an email will open on your device with your answers pre-filled.

1. Personal & Contact Details

THERAPIST NAME

EMAIL ADDRESS

MOBILE NUMBER

2. Training Information

TRAINING COLLEGE / INSTITUTE

COURSE TITLE

YEAR / STAGE OF TRAINING

3. Placement Basics

PREFERRED START DATE

CLIENT HOURS PER WEEK YOU HOPE TO COMPLETE

4. Weekly Availability

AVAILABILITY – DAYS & TIMES

Tap the blocks below to indicate when you are usually available. Availability and flexibility are key for a placement at Cork Counselling Clinic.

Morning
9–12

Afternoon
12–6

Evening
6–10

Mon

Tue

Wed

Thu

Fri

Sat

Sun

NOTES ABOUT AVAILABILITY

5. Motivation & Expectations

WHY THIS PLACEMENT?

WHAT DO YOU HOPE TO GAIN?

6. Clinical Readiness & Supervision

AREAS YOU FEEL MOST CONFIDENT WITH

AREAS YOU FEEL LESS CONFIDENT WITH

EXPERIENCE WITH RISK / CRISIS

7. Ethics, Boundaries & Self-Reflection

BOUNDARIES WITH CLIENTS

ETHICAL THINKING

AREAS YOU WANT TO DEVELOP IN YOURSELF

8. Digital Tools & Clinic Systems

EXPERIENCE WITH DIGITAL TOOLS

PERSONAL DEVICE FOR PROFESSIONAL USE

9. Experience, Supervision & Insurance

PRIMARY MODALITY / APPROACH

CLIENT HOURS COMPLETED (IF ANY)

EXTERNAL SUPERVISION ARRANGEMENTS

PROFESSIONAL INSURANCE

10. Logistics

TRAVEL DISTANCE

MEETING AVAILABILITY

Available for required meetings?

SHORT-NOTICE CLIENT CHANGES

Can you accommodate short-notice schedule changes?

11. Other Placement Arrangements

OTHER PLACEMENTS

Do you currently have any other placement arrangements?

12. Interview Availability

INTERVIEW AVAILABILITY

If offered an interview, are you available during the same days/times you listed?

INTERVIEW CONSTRAINTS

13. Anything Else You Would Like Us to Know

ADDITIONAL INFORMATION

14. Self-Rating (1–5)

Please rate yourself honestly. 1 = Needs significant support — 5 = Very strong/confident

Reliability & punctuality

Flexibility

Comfort with digital tools

Comfort with risk & crisis

Boundaries & ethical awareness

Emotional resilience

Ability to work independently

Motivation & commitment

Cork Counselling Clinic

Cork City

info@corkcounsellingclinic.ie

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Clinical Placement Application

Clinical Placement Application

Therapist Placement Application

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