Vacancy Application Form

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- Step 1 of 10

Surname: *

Telephone (day): *

First name: *

Telephone (evening):

Email: *

Address including post code: *

Application for the position of

Job title: *

Where did you obtain information about this vacancy? *

Have you previously applied for a Mind in the Vale? *

General information (Particulars of spare time interests that you consider may display skills relevant to the position and the skills that you consider relevant to this application. *

School, College, University *

Date *

Qualifications gained *

Include subjects, grades or results expected/attained

School, College, University *

Date *

Qualifications gained *

Include subjects, grades or results expected/attained

School, College, University *

Date *

Qualifications gained *

Include subjects, grades or results expected/attained

School, College, University *

Date *

Qualifications gained *

Include subjects, grades or results expected/attained

Other qualifications (Give details of any other relevant qualifications or records of achievement (e.g. courses attended, certificates attained, including membership and status of any relevant professional or technical association certificate number, date of issue and issuing authority) *

Courses attended/skills acquired (Please summarise any other skills that you have and/or training that you have received that may be relevant to the position applied for) *

Present or most recent employment/voluntary work

Please Note when completing details of your employment or other work record all gaps in service must be accounted for.

Job title: *

Organisation: *

Address: *

From/to: *

Notice period: *

Salary: *

Other benefits: *

Telephone: *

To whom were you responsible? *

Fax: *

How many staff were you responsible for? *

Nature of business: *

Your responsibilities: *

Why do/did you wish to leave? *

Previous work experience/voluntary work (Please start with most recent past experience, adding further jobs or relevant information on a separate sheet) Please ensure that you account for any gaps in service

From: *

To: *

Organisation’s name and location: *

Your position and brief description of duties: *

Reason for leaving: *

From: *

To: *

Organisation’s name and location: *

Your position and brief description of duties: *

Reason for leaving: *

From: *

To: *

Organisation’s name and location: *

Your position and brief description of duties: *

Reason for leaving: *

References

Please give name and details of at least two referees. These should not include relatives or personal friends. You must give the name of your Line Manager in your present or most recent employment as one referee or if you are a college or university leaver your Departmental Head or Tutor. Contracts of employment will only be offered upon receipt of satisfactory references.

Referees will only be contacted if you are successful at interview

Reference 1

Name: *

Relationship: *

Fax: *

Occupation: *

Telephone: *

Email: *

Address: *

Reference 2

Name: *

Relationship: *

Fax: *

Occupation: *

Telephone: *

Email: *

Address: *

Reference 3 - optional

Name:

Relationship:

Fax:

Occupation:

Telephone:

Email:

Address:

Use each point from the Job Description that you are able to meet as a heading and then explain how you meet that specific criteria.

Job description analysis *

Why should Mind in the Vale appoint you to this job? The person specification acts as the selection criteria for the job. The more points on the person specification that you demonstrate that you are able to meet the greater your chance of being invited to interview.

Use each point from the person specification that you are able to meet as a heading and then explain how you meet that specific criteria.

Person specification analysis *

Convictions Rehabilitation of Offenders Act 1974

Have you been convicted of a criminal offence (spent convictions as defined by the Rehabilitation of Offenders Act 1974 being specifically excluded?

Please note: This information will be confirmed with the Disclosure and Barring Service

Convictions Rehabilitation of Offenders Act 1974 *

Safeguarding

Have you any previous convictions, cautions, bind-overs or pending cases affecting your suitability to work with adults at risk (or harm) and children and young people?

Safeguarding *

If YES to either question regarding convictions you are required to give details here. *

Please note: All applicants will be required to undergo an enhanced disclosure and barring service (DBS check) before an appointment can be fully confirmed.

Do you hold a driving licence? *

Has your driving licence ever been endorsed? *

Please give details: *

Declaration *

Declaration

I certify that the information given on this form is, to the best of my knowledge, true and complete and agree that it should form part of the basis of my engagement. Any false statement may be sufficient cause for rejection or, if employed, dismissal without notice.

Confidential Equality and Diversity Monitoring Form

Mind in the Vale is committed to developing positive policies to promote diversity within the organisation. To assist us in monitoring the effectiveness of this policy, we are grateful if you would complete the form below. The information is completely confidential and is used to ensure that employment opportunities are equally available to all suitably qualified candidates.

This form is detached from all applications received by post or e-mail.

1. Age: *

18 - 25 yrs
26 - 35 yrs
36 - 45 yrs
46 - 55 yrs
56+ yrs
Prefer not to say

2.Ethnicity

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box (taken from the 2021 Census).

Ethnicity *

Asian or Asian British
Black, Black British, Caribbean or African
Mixed or multiple ethnic groups
White
Other ethnic group

Asian or Asian British: *

Indian
Pakistani
Bangladeshi
Chinese
Other Asian

Black, Black British, Caribbean or African *

Caribbean
African
Any other Black, Black British, or Caribbean background

Mixed or multiple ethnic groups *

White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or multiple ethnic background

White *

White British
White Welsh
White English
White Scottish
White Northern Irish
White Irish
Gypsy or Irish Traveller
Roma
Other White

Other ethnic group *

Arab
Other background
Prefer Not to Say

Please specify: *

3. Gender *

Male
Female
Transgender
Non-binary
Other
Prefer not to say

Please specify: *

4. Disability *

None
Prefer Not to Say
Deafness/Partial loss of hearing
Blindness/Partial Loss of Sight
Learning Disability
Learning Difficulty
Development Disability
Physical Disability
Long Term Illness
Mobility
Mental Health
Prefer Not to Say
Other

Please specify: *

5.Sexuality *

Heterosexual
Lesbian
Gay
Bisexual
Other
Prefer Not to Say

Please specify: *

6.Religion *

Christianity
Hindu
Muslim
Sikh
Jewish
No religion or belief
Other
Prefer Not to Say

Please Specify: *

7. In the past, I have been *

A Mind employee
A Mind volunteer
A user of Mind’s services

8. Do you have lived experience of mental health (personal experience of mental health issue or as a carer)? *

Yes
No
Prefer Not to Say

Please provide brief details: *

Please provide details of how you became aware of this vacancy. This will help us to monitor the effectiveness of the recruitment media we use. Thank you for your cooperation.

Where did you see this job advertised? (Please be as specific as possible) *

Name: *

Post applied for: *

Reference No. *

Location of post: *

Vacancy Application Form

Application for the position of

Convictions Rehabilitation of Offenders Act 1974

Safeguarding

Confidential Equality and Diversity Monitoring Form

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