Position applied for (please include reference number)*

Where did you hear about this position?*

Full name*

Full address*

Postcode*

Telephone number*

Email address*

How much notice do you need to provide for your current employer(s)?*

What date will you be available to start work?*

If offered this position, will you work in any other capacity?*
YesNo

Have you previously worked for SWWMind or any other local Mind?*
YesNo

Do you require any reasonable adjustments to the recruitment process, including the application process and interview?*
YesNo

Do you have a driving license?*
YesNo

Do you have access to a vehicle?*
YesNo

Reason for leaving current role?

This section is probably the most important part of your application. Make sure you complete this in a concise, well organised, and positive way. We will ask you to attach your CV at the end of this form, so don’t repeat your career history here, refer only to the relevant parts, plus any voluntary, community work or hobby.

Express any relevant views on the requirements specified in the job description and person specification in support of your application.

Please include any skills and experience you have acquired that can support this application whether within the working environment or outside (max 400 words)*

Please state any other training you have attended relevant to the position you have applied for and/or current membership of the professional body/institute to which you may belong/subscribe (max 200 words)

What language(s) can you speak and/or are you able to read in another language?

As part of our equality and diversity policy, SWWMind wishes to ensure that we do not discriminate against ex-offenders.

However, SWWMind operate some services where an ex-offender might be in a potentially vulnerable position, unless consideration of the person’s background has been made. For this reason, we ask you to complete the following section below.

NB. Some posts within SWWMind are exempt from the Rehabilitation of Offenders Act 1974 as they involve working with vulnerable adults and/or children and young people and will require a Disclosure and Barring Service (DBS) check.

Have you ever been convicted of a criminal offence?*
YesNo

If you have any criminal convictions or cautions, please give details of date(s), nature of offence and sentence passed. (If you would prefer to discuss this verbally, please indicate below)

Are there any restrictions regarding your employment in the UK? e.g. do you require a work permit?*
YesNo

Are you a partner or relative of someone who is presently involved with SWWMind (as an employee, service user, or a volunteer)?*
YesNo

I agree that the information given on this form may be processed and saved, in accordance with the Data Protection Act 2018. I agree to the storage of this information on manual and computerised files
I agree

It is understood and agreed that any misrepresentation by me on this application form will be sufficient cause for cancellation of this application and/or termination from the employer’s service if I am employed.

I give the employer the right to investigate all of the references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organisations for furnishing such information.

I agree

Date of Application

At South Warwickshire & Worcestershire Mind, we are committed to ensuring that Equality And Diversity underpins our volunteering activities. With this in mind, we’d be grateful if you could please take a minute to select the options that apply to you from the categories listed below.

This information is collected for monitoring purposes only, and does not form part of your volunteer application. The information you provide is anonymous and will be treated confidentially. By agreeing to fill in this form, you are giving us consent to use this data in our reporting.

What is your gender?*
FemaleMaleNon-BinaryPrefer not to say

Does your gender identity match your sex as registered at birth?*
YesNoPrefer not to say

What is your age?*
Under 1818 – 2425 – 3435 – 4445 – 5455 – 6465 – 7475+Prefer not to say

What is your ethnic background?*
Asian / Asian British – BangladeshiAsian / Asian British – ChineseAsian / Asian British – IndianAsian / Asian British – PakistaniAsian / Asian British – Any other Asian backgroundBlack / Black British / Caribbean / African – AfricanBlack / Black British / Caribbean / African – CaribbeanBlack / Black British / Caribbean / African – Any other Black / Black British / Caribbean backgroundMixed / Multiple Ethnic Groups – White & Black CaribbeanMixed / Multiple Ethnic Groups – White & Black AfricanMixed / Multiple Ethnic Groups – White & Black AsianMixed / Multiple Ethnic Groups – Any other Mixed / Multiple Ethnic backgroundWhite – English / Welsh / Scottish / Northern Irish / BritishWhite – IrishWhite – Gypsy or Irish TravelerWhite – RomaWhite – Any other White backgroundOther Ethnic Group – ArabOther Ethnic Group – Any other Ethnic GroupPrefer not to sayOther

What is your marital status?*
MarriedSingleLiving with PartnerPrefer not to sayOther

What is your religion, faith or belief?*
No religionBuddhistChristianHinduJewishMuslimSikhPrefer not to sayOther

What is your sexual orientation?*
Hetrosexual / StraightGay / LesbianBisexualPrefer not to sayOther

Do you consider yourself to have a disability?*
YesNoPrefer not to say