Mental health nursing supervisor application

Details

First name *

First name is required.

The text you enter in the above text box will show on your public listing

Last name *

Last name is required.

The text you enter in the above text box will show on your public listing

Email address *

Email address is required.

The text you enter in the above text box will show on your public listing

Where do you live? *

Where do you live is required.

Phone number for database managers to contact you on *

Phone number is required.

Mobile or landline, please include area code. The purpose of collecting your phone number is for the database managers to contact you if necessary.

Phone number for listing publicly if you choose

The text you enter in the above text box will show on your public listingMobile or landline, please include area code

Discipline *

Discipline is required.

Service/organisation *

Service/organisation is required.

Typical session length

minutes

The text you enter in the above text box will show on your public listing if you state a session costPlease write this in minutes, for example one-and-a-quarter hours is 75 minutes.

Your rate for a session of typical length

$

The text you enter in the above text box will show on your public listing if you state a session cost

Please add any further cost information for supervisees below

The text you enter in the above text box will show on your public listing. Include cost for within service and outside service.

Are you available to provide supervision under a reciprocal arrangement?

Yes

No

Experience

About me *

About me is required.

The text you enter in the above text box will show on your public listing Please describe your background in a paragraph or two. This is the first information that people will read about you. You may wish to include what interests you, your values, languages spoken, diversity etc.

My experience *

My experience is required.

The text you enter in the above text box will show on your public listing Minimum 2 years in a designated mental health role is required List here designated mental health roles you have held. This will assist supervisees to determine if you have had the experience that is relevant to them. This may include role title, organisation, clinical or non-clinical sector, any other important characteristics of the roles.

My current role/work

The text you enter in the above text box will show on your public listing Provide details of your current position to support supervisees confidence in the relevance of your role to their work. This may also assist in determining any conflicts of interest if you are working for the same organisation.

My training *

My training is required.

The text you enter in the above text box will show on your public listing Specify any relevant training you have engaged in.

Do you supervise from an intersectional lens? If yes, please indicate relevant experienceYour response below will show on your public listing. Select as many as apply.

First Nations

LGBTQI+

Culturally and Linguistically Diverse background

Family violence

Disability

AOD

How many years of discipline-specific practice do you have?

How many years have you been providing discipline-specific supervision?

My approach to supervision *

My approach to supervision is required.

The text you enter in the above text box will show on your public listing Describe in a short paragraph or two the approach you take towards supervision, your values as a supervisor, any methods or tools you use, why you are offering this service, what motivates you and what you aim to provide. Include any other information that will assist the supervisee to determine a suitable match.

Availability and delivery

Do you have experience in providing group supervision? *

Yes

No

Please indicate if you have experience providing group supervision.

What format of supervision do you provide? *Your response above will show on your public listing

Individual

Group

Please select at least one supervision format.

What frequency of supervision can you provide? *Your response above will show on your public listing.Tick as many as apply.

Monthly

Fortnightly

Weekly

Please select at least one supervision frequency.

Mode of delivery *Your response above will show on your public listingSelect all that you are able to provide.

Online

In person

Phone

Please select at least one mode of delivery.

In what geographical areas are you able to provide supervision in person?

This field is optional. The text you enter in the above text box will show on your public listing. Please list a few suburbs or the general area/region you practice in.

Further comments about your availability

This field is optional. The text you enter in the above text box will show on your public listing. Please state if you are able to attend other services for individual or group supervision.

Consent

I consent for my public information to be made available in the supervisor database. *

You must consent for your public information to be made available.

I confirm I have capacity to provide supervision. *

You must confirm you have capacity to provide supervision.

I agree to receive supervisor database communications from VCCMHW *

You must agree to receive supervisor database communications.

I would like to receive the VCCMHW newsletter and mental health sector communications

Mental Health Nursing Supervisor application

Minimum criteria

Please fix the following errors:

Details

Experience

Availability and delivery

Consent