Career Counselling Intake Form

bgf.org.au

Career Counselling Intake Form

Career Counselling Intake Form

Name:

Home phone:

Mobile:

Email:

Mailing Address:

Date:

Is it ok to leave a message on this number? Y / N

Is it ok to leave a message on this number? Y / N

Is it ok to email you? Y / N

Is it ok to send you mail? Y / N

Current occupational status: _________________________________________________

Emergency Contact Name: ___________________________________________________

Emergency Contact Phone: __________________________________________________

Emergency Contact Relationship : _____________________________________________

How were you referred/how did you hear about BGF Career Counselling?: _____________

________________________________________________________________________

In order for the Career Counsellor to best support you, please answer the questions below.

Please return the form a minimum of 3 days prior to your first career counselling session by

fax: 9283 8732 or email: gitte.backhausen@bgf.org.au

Why have you decided to seek career counselling?

What do you hope to accomplish from career counselling?

How can I as your Career Counsellor have the most impact on your life while we work

together?

What ideas do you already have in regards to what area of work you would like to get into/or

career change you would like to make?

What kinds of barriers could get in the way of meeting your career goals?

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Briefly list the highest level of formal education you have obtained and any other relevant

education, certificates, or specialised training:

What subjects have you most enjoyed studying?

What subjects have you least enjoyed studying?

List aspects of all of prior work and study experience that you MOST liked:

List aspects of all of your prior work and study experience that you LEAST liked:

If you could do any job / occupation you wanted, what would it be?

Which values are most important to you regarding your work? Please circle 3-5 from below:

Achievement Environment Leadership Stability Enjoyment

Creativity Money Moral Fulfilment Security Competition

Helping others Status/recognition Intellectual Stimulation Variety

Challenge/adventure Helping society Free time/leisure Self-Direction

Authority

Independence

What can you do easily that other people find difficult?

What is difficult for you that others seem to find easier?

Who or what has impacted your career choices so far?

How do you like to spend your leisure time/what are your hobbies?

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