Herefordshire Mind Application Form

Employment Application Form
All data that is collected and processed during the job application process is subject to Herefordshire Mind's Job Applicant Privacy Notice.
About you
Name:

PrefixFirst NameLast Name
Preferred pronouns:
E-mail address:
Phone number:
Home address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which role are you applying for?
Where did you hear about this vacancy?

Eligibility to work in the UK
Are there any restrictions regarding your employment in the UK? (e.g. do you require a Work Permit?)
Disability

As part of our commitment to equality of opportunity, we guarantee to interview disabled applicants who meet the minimum requirements of the post.
Do you consider yourself to have a disability (as defined by the Equality Act 2010)?
Do you have any special requirements to enable you to attend interview or assist you in the interview process?
Please give details of any reasonable adjustments you require:
Criminal convictions
Due to the nature of Herefordshire Mind’s work, most of the posts are exempt from the Rehabilitation of Offenders Act 1974 and we use the Disclosure and Barring Service (DBS) to assess current and prospective employees’ and volunteers’ suitability for positions.

We fully comply with the DBS Code of Practice and undertake to treat all employees and applicants for employment and voluntary positions fairly. We undertake not to discriminate unfairly against any subject of a Disclosure on the basis of conviction or other information revealed.

Our policy on Recruitment of Ex-Offenders and DBS is available to download.
Have you ever been convicted of a criminal offence?

Education & Training

Please give details of your educational qualifications. You may be required to provide proof of qualifications and training courses.
Education & professional qualifications
Relevant training
Are you a member of a professional body (e.g. BACP, BPS, NMC)?
Please give further details:
Driving for work

Some roles may require you to drive clients using a company vehicle or to use your own vehicle for business purposes.
Do you have a current driving licence?
Do you have access to a vehicle?
Outside activities and interests
Please tell us about your main interests and hobbies outside of work:

Current/most recent employment details
Name of current/most recent employer:
Address of most recent employer:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
When did you start working for this employer?

DayMonthYear
Date
When did you finish working for this employer? (if applicable)

DayMonthYear
Date
What is/was your position?
Please tell us about the duties you perform/ed in this role:
Reason for leaving?
Do you have any other previous employment?

Previous employment details

Please give details of all previous paid or voluntary positions held since completing your full time education, starting from the most recent and working backwards.
- Name of previous employer 1:
- Address of previous employer 1:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- When did you start working for this employer?
  
  DayMonthYear
  Date
- When did you finish working for this employer?
  
  DayMonthYear
  Date
- What was your position?
- Please tell us about the duties you performed in this role:
- Do you have further previous employment?
- Name of previous employer 2:
- Address of previous employer 2:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- When did you start working for this employer?
  
  DayMonthYear
  Date
- When did you finish working for this employer?
  
  DayMonthYear
  Date
- What was your position?
- Please tell us about the duties you performed in this role:
- Do you have further previous employment?
- Name of previous employer 3:
- Address of previous employer 3:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- When did you start working for this employer?
  
  DayMonthYear
  Date
- When did you finish working for this employer?
  
  DayMonthYear
  Date
- What was your position?
- Please tell us about the duties you performed in this role:
- Do you have further previous employment?
- Please give details of any other previous employment:
  Please include the month and year for your employment history.

References

Please give the names and contact details of two referees, who should not be related to you. References will not be taken up until an offer of employment is made.
Reference 1

This referee should be your present or most recent employer.
Name:

First NameLast Name
Organisation:
Position:
Phone number:
Email address:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Name:

First NameLast Name
Organisation:
Position:
Phone number:
Email address:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supporting information & declaration
Please give your reasons for applying for the post and outline your relevant experience, qualifications and skills, making reference to the person specification for this role, which is available to download from the Herefordshire Mind Jobs page.
The information supplied here plays a significant part in the selection process, therefore it is important that you complete this section in as much detail as possible.
Should be Empty:

Employment Application Form

About you

Eligibility to work in the UK

Disability

Criminal convictions

Education & Training

Driving for work

Outside activities and interests

Reference 1

Reference 2

Supporting information & declaration