APPLICATION FORM

Please complete this application and return via email to or by post to the address below:

Plymouth and District Mind

8 Woodside, Greenbank

Plymouth

PL4 8QE

Tel: (01752) 512280

POSITION APPLIED FOR: Mental Health Recovery Worker

Application No (OFFICE USE ONLY):

1.EDUCATION

a)SecondarySchool/College/University (including current studies). Please start with most recent.

Name / Courses taken/subjects / Dates / Qualifications/Grade*

* Proof of qualification will be required

b) Other relevant training or work related skills

(e.g. short courses, first aid, languages, computer skills, work based NVQ etc.)

2. EMPLOYMENT HISTORY

a)Present employment:

Employer’s name and address:

Position held:

Date appointed:Present salary:

Brief description of duties:

b) Previous posts (please start with most recent)*

Name and address of employer / Job/title
Principle duties / Dates
From - to / Reason for leaving

c) Please give details and an explanation of any gaps in your employment history:

3. PROFESSIONAL MEMBERSHIP

Please state organisation, grade or membership (whether by examination) and date of entry.

4. SUPPORTING STATEMENT

Please use this section to provide further information in support of your application. This needs to be related to the requirements of the post and should cover the following:-

  • The experience, skills, knowledge and personal qualities which you consider make you suitable for the post.
  • Details of any voluntary work, relevant leisure activities, contact with particular interest groups.
  • Reason for applying and the contribution you feel you will make to the post.

(Continue on a separate sheet if space in insufficient)

5. ADDITIONAL INFORMATION

Do you have a full driving license?

Do you have use of a car?

Do you require a work permit?

If appointed, date on which you are free to commence your duties:

6. REFERENCES

Please give below, names and addresses of two referees, one of whom must be either your present or previous employer. If this is your first job, then your school or college. Names of friends or relatives may not be submitted for reference.

Reference 1 / Reference 2

Position held: Position held:

Tel No: Tel No:

We will not contact your references unless you are appointed. All appointments are subject to suitable references. We retain the right to seek references from all previous employers.

7. REHABILITATION OF OFFENDERS

This post is exempt from the provisions F Section 4 (2) of the Rehabilitation of Offenders Act 1974. Applicants are therefore not entitled to withhold information about convictions which for the purpose “have expired” under the provisions of the Act and in the event of employment failure to disclose such information could result in dismissal. The successful candidate will be asked to complete a Subject Access Form. This gives permission to the Police to provide a statement indicating any conviction history.

Have you ever been convicted for criminal offence?

If Yes, please record details of any convictions with dates. This should include driving convictions and cautions.

8. DECLARATION

I declare that the information given in this application is, to the best of my knowledge, complete and correct. I understand that if, after appointment, any information is found to be inaccurate this may lead to dismissal without notice.

Print Name:

Signature/E-Signature:

Date:

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