Charnwood Mental Health Trust

LWA – Living Without Abuse Post of LWA Outreach Worker

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Application Form

1 PERSONAL DETAILS

Surname:
Address:
Postcode: / First names:
Telephone No. Evening: / Daytime (if available):

Do you have a driving licence and access to a vehicle? Yes No

2 REFERENCES

Please give details of two referees, one of whom should be your current or most recent employer.

Name:
Address:
Tel No:
Position Held:

Work Related? Yes No

Are you related to this person? Yes No / Name:
Address:
Tel No:
Position Held:

Work Related? Yes No

Are you related to this person? Yes No

Please note, references will only be taken up in the event of you being offered the position, and with your knowledge.

Please note that the questions in Section 5 relate to Essential Criteria, and any applicant not answering them CANNOT be shortlisted.

Supporting information will not be read by the Shortlisting Panel.

THIS PAGE WILL NOT BE READ BY THE SHORTLISTING PANEL.

CODE:______

WE WOULD BE EQUALLY HAPPY WHETHER YOU HAND-WRITE IN THESE SPACES OR WORD-PROCESS ON SEPARATE SHEETS FROM THIS POINT ONWARDS

3 WORK EXPERIENCE INCLUDING VOLUNTARY WORK

Please begin with most recent or current post

Employer/Organisation / Job Title / Dates
From To / Reasons for leaving

4 SECONDARY EDUCATION AND TRAINING UNDERTAKEN

Please include all training events undertaken and any qualifications gained.

School/Organising Body / Dates
From To / Qualifications gained - please include any achieved in another country; these will be considered positively

5. ESSENTIAL EXPERIENCE AND SKILLS

REMINDER: Please note that all questions in Section 5 relate to Essential Criteria, and any applicant not answering them CANNOT be shortlisted.

1. Please give details of any experience you have of the following:

i. working with personal support and information services

ii. the use of basic IT programmes, email and the internet

iii. working under pressure whilst effectively managing a varied workload

iv. establishing and maintaining good productive relationships with a wide variety of people

2. Please explain what you understand by the following-:

i. the scope of domestic abuse

ii. the ways in which the different aspects of domestic abuse can affect individuals, including children

iii. the need to work both methodically and flexibly in a service like Outreach in response to the needs of service users and colleagues

iv. the importance of accurate timely record keeping and data collection

v. working in an equal opportunities way in order to deliver the Outreach service

6. SUPPORTING STATEMENT

Please give us any further information about yourself in support of your application. You may wish to refer to any of the essential and desirable criteria in the Person Specification that you might meet.

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THIS PAGE WILL NOT BE READ BY THE SHORTLISTING PANEL

To the best of my knowledge, all information given in this application is accurate

Signed…………………………………………..Date……………………………….

Please return this form:

JUDITH ROBINSON

65 FOREST ROAD

LOUGHBOROUGH

LEICESTERSHIRE

LE11 3NW

Closing date for applications is 12 midday on Monday 7th October 2013. Please note that applications received after this time will not be read/considered for shortlisting.

Interviews will take place on Monday 14th October 2013.