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VfMH Application Form 03/14

APPLICATION FORM

Personal Details
Title:
Forenames:
Surname:
Address:
Postcode:
Telephone:
Mobile:
Email:
Date of Birth:
Age:
Nationality:
Years Lived in the UK:
Do you have the right to live in the EU? Y/N
Do you need a visa to work in Romania? Y/N
Volunteers for Mental Health (VfMH) is a small charity, entirely run by volunteers. At present we are only able to accept UK based applicants who have the right to work in the EU. Interviews and training are in the UK, and for this reason, we can only accept UK based individuals
Current or Most Recent Employment
Job Title
Name of Employer
Address of Employer
Brief Outline of Duties and Responsibilities
Start Date
Leaving Date
(if applicable)
Reason for Leaving
(if applicable)
Notice Required
Previous Employment & Relevant Work Experience (please use additional sheets as required)
Job Title and Main Duties / Employers Name and Address / Dates
(From – To) / Reason for Leaving
Education, Training and Personal Development
Place of Study/Training / Dates
(From – To) / Achievements and Grades
Supporting Information
Please use this page to tell us why you are applying for a placement with VfMH. Highlight any voluntary or personal experience that you think is relevant to the position.
We use the volunteer specification to decide who to shortlist for interview so you will need to demonstrate here how you meet the criteria detailed on the volunteer specification.
Please use additional sheets as required.
Medical History
Please give details of any illnesses (physical, mental, alcohol or drug related) that have persisted for more than a week and of any ongoing treatment or disability.
Would you be willing to have a medical examination if necessary?
How many days sickness have you had over the past year?
Disclosure of Criminal Convictions
Have you ever been convicted of a criminal offence? (please circle)YES NO
If yes, please give details including date(s)Do you have any court cases pending? (please circle)YES NO
If yes, please give details including date(s)Applicants who are offered a placement with VfMH will be subject to a criminal record check from the criminal record bureau before the appointment is confirmed. This will include details of cautions, reprimands and final warnings as well as convictions.
Where did you see this post advertised?
Please give details of which publication/poster/website/other you heard about VfMH from.
Placement Dates
Our placements run from 2 – 6 months in duration. Please indicate when you are looking to go on placement and the length of time you are available for (the more flexible the better).
Please note: We have a minimum requirement of 2 volunteers per placement. In the event that we are unable to run your placement due to insufficient volunteer numbers, you will be offered a later placement.
References
An offer of a placement is subject to two satisfactory references. Please give the details of two referees. One of these should be your current or most recent employer. A reference from a family member may not be used.
NB: Referees will only be contacted after a success interview.
1. Name: Occupation:
Capacity in which they know you:
Address:
Postcode: Telephone:
Email:
2. Name: Occupation:
Capacity in which they know you:
Address:
Postcode: Telephone:
Email:
Declaration

I confirm that the information on this form is, to the best of my knowledge true and complete.

Signature Date

Please return this form to

Or post to:12 Dovecote Mews, Manchester, M21 9HN.