Mind in Harrow

APPLICATION FORM

Job applied for: / Stepping Stones Project Coordinator
Where did you hear of this vacancy?

Personal details:

Surname: / Full First Names:
Telephone No. (home or mobile) / Telephone No. (work)
Email Address:
Address:
Postcode:

Can we ring you at work?YES / NO

References:

Please give names and addresses of two people, not related to you, to whom we may apply for references. One should be your present or recent employer. The second referee may be a personal referee but not a member of your family.

Reference 1 (present or recent employer) / Reference 2
Name: / Name:
Post: / Post:
Address: / Address:
Telephone: / Telephone:
Email: / Email:

May we approach the above individuals without further reference to you? YES / NO

Availability:

When would you be able to take up a new appointment?

Please note that CV’s will not be accepted.
Education and Qualifications:

Please list any relevant educational or training achievements:

College / Centre / Dates
From To / Education / Training
Completed

Present employment or most recent (Paid or voluntary):

Job Title:
Period of work (from and to):
Reason for leaving:
Employer’s name & address:
Description of main responsibilities:

Employment history:

Please give details of your previous paid or voluntary employment (start from the most recent).

Name and Address / Dates
From To / Brief Description
of Work

Mental Health Awareness:

Please state briefly what you understand by the term mental health problems, their causes and available treatments.

Disclosure and Barring Service (DBS) Checks

Because Mind in Harrow works with vulnerable people, it is our policy to carry out DBSchecks on all staff, trustees, and volunteers. We comply with the DBSCode of Practice and undertake not to discriminate unfairly against any subject of a Disclosure on the basis of conviction or other information revealed. A copy of our Recruitment of ex-offenders policy is available on request. We require all applicants to provide details of any criminal record at the earliest stage in the application process. Therefore we request that this information be sent under separate, confidential cover to Mark Gillham, the CEO at Mind in Harrow,First Floor, 132 - 134 College Road,Harrow, HA1 1BQ. We guarantee that it will only be seen by those who need to see it as part of the recruitment process.

Data Protection Act

By submitting this application form you give permission for Mind in Harrow to hold information about you relating to the project(s) you have applied for, and to share information about you with other organizations for purposes of safeguarding and emergencies for your safety or the safety of others. At no time will your personal information be passed to organisations for marketing or sales purposes.

Supporting Statement

Please use the space below to explain why you are interested in this position by addressing all the criteria in the Person Specification. You need to give evidence or examples to show that you fulfil the criteria in the same order as the Person Specification. Please limit your supporting statement to three sides of A4 paper. If your supporting statement is handwritten please attach it to the application form.

We will be shortlisting on the basis of these criteria.

Please return your completed form to: Recruitment Admin, Mind in Harrow,

First Floor, 132-134 College Road, Harrow, Middlesex, HA1 1BQ

Signed...... Date......