JOB APPLICATION

Application for the post of: Service Manager

Part A: Personal details

(Please use block letters in this Section)

Surname:
First name:
Address:
Post code:
E-mail address:
Home telephone number:
Work telephone number: / May we contact you at work? / Yes / No *
Are you eligible to work in the UK? / Yes / No * / Can you provide evidence of this? e.g. National Insurance card / P60 etc. / Yes / No *
If you have a disability are there any arrangements which we can make for you if you are called for an interview? Yes / No *
If YES, please specify, e.g. parking space, ground floor venue, etc.

* Please delete as appropriate


Part B: Present or most recent employment

Please give details of your current or most recent employment.
Name and address of employer:
Type of business:
Your job title:
Main duties and responsibilities:
Dates of employment: / Notice period required: / Salary:

Part B continued: Employment

Please put the most recent first, you may continue on up to one sheet of A4 if necessary.
Job title / Name and addressof employer / Main duties / From / To

PART C: Education and Qualifications

Please give details of your education and the qualifications obtained.

Primary school details are not required.

Name of school,
college, university etc. / Qualifications and levels achieved / Dates attended
Part D: Training

Please give details of any training you have had, which may support your application.

Title of training course
and brief description / Certificates/qualifications gained / Dates attended
Part E: Professional Association Membership
Name of professional association / Year of membership / Grade/level

Part F: personal statement

We will shortlist candidates for interview based on the extent to which they meet the criteria listed in the person specification.

Please use the space below to go through each point of the person specification and tell us how your skills, knowledge, experience and abilities correspond to the criteria we have listed.

If you need to you may continue for up to 2 additional sheets of A4 paper.

Please tick if you are attaching continuation sheets:

PART G: REFERENCES

Please give details of two referees we may ask for references. One referee must be your current (or most recent) employer. If you have not been in paid employment, your referee may be the head of an educational or training establishment and/or the manager of a voluntary group for which you have worked.

Referees will not be contacted unless you are offered a position at RB Mind.

Name of referee:
Capacity in which known to you:
Position:
Organisation:
Address:
Telephone No: / Name of referee:
Capacity in which known to you:
Position:
Organisation:
Address:
Telephone No:

PART H: Declaration of criminal offence

As all RB Mind employees are working with potentially vulnerable people, we are legally entitled to request candidates to declare all previous criminal convictions. Please give details of dates, types of offence, sentence/fine imposed etc. Successful candidates will also be required to undertake a Criminal Records Bureau check and confirmation in post is subject to the contents of this.

Part i: declaration

I certify that, to the best of my knowledge, the information I have provided on this form is true and accurate. I understand that if the information I have supplied is false or misleading in any way, it will automatically disqualify me from appointment or render me liable to dismissal without notice.
Signed: ______Date: ______

Where did you hear about this job opportunity?

Thank you for the time you have taken to complete this form.

Please send it back to RB Mind, Richmond Community Healthcare Hamlet, Kew Foot Road, Richmond TW9 2TE or email it to by the 9AM on Monday December 15th, 2014.

Please do not forget to include any additional sheets and your Equal Opportunities Monitoring Form.

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