mindyourself

Application Form

Please note that we keep this information confidential.

1 / Personal Details
First Name / Last Name
Address Line 1
Address Line 2
Address Line 3
Mobile Phone / Landline Phone
Email Address / Other Email
2 / Application Details
Job Title
Job Location
Where did you see the role advertised?
3 / Availability
When are you available to start?
There is some London wide travel as part of this role. Are you available to travel?
5 / Visa/Permits
Are you eligible to work in the UK?
6 / Work History
Please list details of your previous roles starting with your current/most recent role.
Position 1 (Most Recent)
Employer / Location
Title / Supervisor & Title
Date From / To / Reason for Leaving
Salary / Other Benefits
Responsibilities & Achievements [please expand as necessary]:
Position 2
Employer / Location
Title / Supervisor & Title
Date From / To / Reason for Leaving
Salary / Other Benefits
Responsibilities & Achievements [please expand as necessary]:
Position 3
Employer / Location
Title / Supervisor & Title
Date From / To / Reason for Leaving
Salary / Other Benefits
Responsibilities & Achievements[please expand as necessary]:
Position 4
Employer / Location
Title / Supervisor & Title
Date From / To / Reason for Leaving
Salary / Other Benefits
Responsibilities & Achievements[please expand as necessary]:
Other Employment (Please use additional paper to list other employment)
From / To / Title / Employer / Location
7 / Education & Training
Degrees, Diplomas, Certificate, Licences, Training Courses (List additional information on a separate page)
From / To / Course / Qualification / Institution / Location / Grade
Please list any relevant organisations or professional bodies of which you are a member
8 / Tell us what you think
  1. Outline the aspect of the role that appeals to you the most?(max 200 words)

  1. Tell us about your ability to work with vulnerable people (max 200 words)

  1. Tell us about your experience of designing and delivering group activities (max 200 words)

9 / Business Applications
Please indicate skill level. (Basic / Intermediate / Advanced)
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Microsoft Outlook
Other Email Systems
Other Systems
10 / Retention of your Records
This form will be used by Mind Yourselfto help assess your suitability for employment and may be used for appropriate checks. We will retain your application in accordance with Irish employment law. If your application on this occasion is unsuccessful, we may retain your records in case other opportunities arise in the future which we think may be of interest to you. If you do not wish us to do so; please tick this box.
11 / Criminal
Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.
In addition you are required to submit to a Criminal Records Bureau check. Any standard or enhanced disclosure made by the CRB/SCRO will remain strictly confidential.
Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? YES/NO (delete as required)
If YES, please give details
12 / Referees
Name / Name
Address / Address
Telephone No / Telephone No
Email address / Email Address
Role / Role
Relationship to you / Relationship to you
13 / Declaration
I confirm that the information provided on this form and any attachments are accurate and complete. I understand that any misleading statements are sufficient for termination of any agreements made. I understand that any information later discovered to be incorrect may result in the termination of any agreements made. I agree that any future offer of employment is subject to satisfactory references, health clearance, and having the required work permit.
Name / Signature / Date
14 / mind yourself
We are Mind Yourself. We work to improve the health and wellbeing of the Irish community in London. We recognise and celebrate the diversity of Irish identity. We are equal opportunity employers

Mind Yourself Application Form