Dorset Mind Employment Application Form

Using this Application Form

All sections on this form are to be completed clearly. Please ensure you read in full the Job Description and Person Specification before filling out your application. Forms that do not meet requirements set out in these guidance notes will not be considered.

Data Protection

In accordance with our Privacy Statement (which can be viewed on our job vacancies webpage), we take care to ensure all applicant data is appropriately and securely stored and handled. Any information supplied in connection with an application for employment will be kept securely for a period of six months and then will be destroyed.

Any information with regards to successful candidates who are subsequently employed by Dorset Mind will be moved into their staff file and be handled in line with our Retention and Disposal Schedule. If you have any further information about our approach to Data Protection, please see the Privacy Notice on our website or contact us via recruitment@dorsetmind.uk

Criminal Convictions

As part of its equal opportunities policy, Dorset Mind wishes to ensure it does not discriminate against ex-offenders. If you have any convictions that are unspent under the Rehabilitation of Offenders Act 1974, please supply details of your conviction(s) via the personal details section of this form.

Some posts are exempt from the Rehabilitation of Offenders Act 1974 as they involve working with vulnerable adults and will require a Disclosure and Barring Service (DBS) check. If you have applied for an exempt post, please supply details via the personal details section of this form.

Eligibility to work in the UK

If there are any restrictions regarding your employment in the UK (e.g., you require a Work Permit), please supply details via the personal details section of this form. Please note Dorset Mind is not able to sponsor Visas.

Equal Opportunities

Dorset Mind is an Equal Opportunities Employer and welcomes applicants from a diverse range of backgrounds.

Personal Details (this section will be removed before shortlisting)

This part of the form is used to collect information about you in the event that you are shortlisted for the role you are applying for and to make us aware of any restrictions to your employment.

The information from this section of the form will not be shared with the recruitment panel until after shortlisting has taken place.

Application Form

The information from this section of the form will not be shared with the recruitment panel until
after shortlisting has taken place.

Application Information

Please state the title of the post you are applying for:

How did you hear about the position?

Your Details

First Name:

Surname:

Address including
Post Code:

Main Phone Number:

Alternative Number:

Email Address:

Do you hold a current UK Driving Licence and access to transport to undertake the requirements of the post?

Yes

Eligibility to work in the UK

If there are any restrictions regarding your employment in the UK (e.g., you require a Work
Permit), please supply details below. Please note Dorset Mind is not able to sponsor Visas.

I have no restrictions regarding my employment in the UK

I have restrictions regarding my employment in the UK (please give details below)

Criminal Convictions Declaration

As part of our equality and diversity policy, we wish to ensure we do not discriminate against ex-offenders. If you have any convictions that are unspent under the Rehabilitation of Offenders Act 1974, please let us know and provide details below. Please note that some posts are exempt from the Rehabilitation of Offenders Act 1974 as they involve working with vulnerable adults and will require a Disclosure and Barring Service (DBS) check. If you have applied for an exempt post, please supply details below.

I do not have any unspent criminal convictions

I am applying for an exempt post and understand that a DBS check will be carried out if I am successful in my appointment

I have an unspent criminal conviction (please supply details below)

References

Please give the names and contact details of two referees. One referee should be your
present or most recent employer. References will not be taken up until an offer of employment
has been made.

Referee 1

Referee 2

Name of Referee 1:

Name of Referee 2:

Relationship to you:

Occupation:

Organisation:

Email Address:

Telephone Number:

Other Factors

Please use this space if you would like to tell us about any way in which Dorset Mind could
support you to apply for the post, for example by providing alternative versions of the
information provided, assistance with attending the interview or any other adjustments.

Declaration

I confirm that to the best of my knowledge all information I have given in my application is correct and can be treated as part of any subsequent contract of employment. Any false, deliberate omission, or misleading information may be sufficient cause for rejection or, if employed by Dorset
Mind, to be dismissed.

I agree Dorset Mind can approach any of my previous employers for a reference to confirm that any information given in relation to my application is correct.

I consent to Dorset Mind storing and processing my application in line with their policies and procedures and in line with the Data Protection Legislation.

Please tick this box to confirm

The information from this section of the form will be shared with the recruitment panel until after shortlisting has taken place.

Current Employer

Name and Address:

Job Title:

Brief Summary of responsibilities:

Dates of employment:

Notice Period:

Previous Employers

Name and Address:

Job Title:

Brief Summary of responsibilities:

Dates of employment:

Education

Please give details of your educational qualifications and training. You may be required to provide proof of qualifications and training courses.

Date:

School / College / University:

Qualification:

Grade:

Other Training including Continued Professional Development

Please state any other training you have attended relevant to the position you have applied for:

Are you a member of a professional body or organisation?

Date:

Name of Body / Organisation:

Membership:

Residency

Have you lived outside the UK at any time for a period longer than 6 months?

Yes

Country of residence:

Date From:

Date Until:

Suitability for the post

Please describe any qualifications experience personal qualities and any other relevant factors that make you suitable for the role

Other Employment

As part of our commitment to good employment practice we will not usually employ permanent or contracted staff who have a regular commitment to study or work with another organisation when total study/working hours exceed 48 per week.

Do you have a regular commitment to study or work with another organisation?

Yes

If you answered yes, please provide details:

Equality Monitoring Form

Dorset Mind is committed to a culture for staff, volunteers, and participants that promotes equality and celebrates diversity. To help us monitor and achieve this, we gather and use information to continually improve our policies and processes and to remove barriers to either working with us or accessing our services. The information you give is confidentially managed and will not affect your participation in our services, or your application to work/volunteer with us.
It will help us if you provide as much information as possible, but if you do not wish to answer any questions please leave them blank.

Gender

Female

Male

Non-binary

Transgender

Prefer not to say

If you prefer to use your own term or pronoun, please provide this here:

Sexual Orientation

Bisexual

Gay Man

Gay Woman / Lesbian

Heterosexual/Straight

Non-Binary/Pan-Sexual

Prefer not to say

If you prefer to use your own term, please provide this here:

Do you consider yourself to have a disability or long-term condition that has a substantial impact on your ability to carry out day-to-day activities (including sight or hearing loss)?

Yes

Prefer not to say

If you answered yes is it:

A Physical Health Condition

A Mental Health Condition

Prefer not to say

If you would like to give us brief details and information about how we can support you please do so here:

Do you consider yourself to be neuro-diverse (i.e., on the autism spectrum)?

Yes

Prefer not to say

If you would like to give us brief details and information about how we can support you please do so here:

Do you have a learning difference? (this can include dyslexia etc)

Yes

Prefer not to say

If you would like to give us brief details and information about how we can support you please do so here

Ethnicity

Black

African

Carribean

Other Black Background

White

British

Irish

Eastern European

Another White Background

Asian

Bangladeshi

Chinese

Indian

Pakistani

Another Asian Background

Mixed

White & Asian

White & Black African

White & Black Carribean

Another Mixed Background

Other ethnic group

Arab

Gypsy or Traveller

Another Background

Prefer not to say

Religion and belief

Agnostic/Atheist

Hindu

Muslim

Buddhist

Jewish

Sikh

Christian

None

Other

If you prefer to use your own term, please provide this here:

prefer not to say

Relationship Status

Single

Married/Civil Partnership

Separated

Widowed

Divorced

with Partner

Prefer not to say

Other Information

Year of birth

Prefer not to say

Nationality

Prefer not to say

Are you a Carer?

Yes

prefer not to say

If you would like to give us brief details and information about how we can support you please do so here:

If this form has made you feel excluded, uncomfortable or you have any other feedback, please use this space to tell us about it, as your input is valuable to us:

AFC Bournemouth x Dorset Mind at Vitality Stadium

Fitness/ Wellbeing Workshop

2 Dates Available. Limited Spaces

Application Form

Dorset Mind Employment Application Form

Application Form

Application Information

Your Details

Eligibility to work in the UK

Criminal Convictions Declaration

References

Other Factors

Declaration

Current Employer

Previous Employers

Education

Other Training including Continued Professional Development

Are you a member of a professional body or organisation?

Residency

Suitability for the post

Other Employment

Equality Monitoring Form

Gender

Sexual Orientation

Do you consider yourself to have a disability or long-term condition that has a substantial impact on your ability to carry out day-to-day activities (including sight or hearing loss)?

Do you consider yourself to be neuro-diverse (i.e., on the autism spectrum)?

Do you have a learning difference? (this can include dyslexia etc)

Ethnicity

Religion and belief

Relationship Status

Other Information

Are you a Carer?

Please support our work

Live life mentally healthy