job application

Candidate reference number FOR OFFICE USE ONLY

Short listed YES NO Interview Date Successful YES NO COL Date Ref 1 Req Rec Ref 2 Req Rec R Date FOL Date Contract Date

Please ensure that you have quoted the vacancy reference number:

RETURN TO Rethink HR Service Centre 1st Floor Castlemill Birmingham New Road Tipton DY4 7UF

Personal details
Title Surname Address Postcode Home Tel No. Work Tel No. May we contact you at work? Yes No Email Where did you see the vacancy advertised? Do you require a work permit to work in the UK? (Mr/Mrs/Miss/Ms/Dr/Other) Forename

Yes

No

Current or most recent employer

Name Address Postcode Tel No. Position held Duties Start date End date Salary

Notice period (if applicable)

Previous employment please give most recent first

Please give details of employment (paid or unpaid) over the last 10 years Name and nature of business Dates From To Position held Reason for leaving

Working together to help everyone affected by severe mental illness recover a better quality of life
Registered in England Number 1227970. Registered Charity Number 271028. Registered Office: 89 Albert Embankment, London, SE1 7TP. Rethink is the operating name of the National Schizophrenia Fellowship, a company limited by guarantee.

Education please give most recent first

Please give details of all qualifications obtained, along with grade and date achieved Name and address of school/college/uni Dates From To Course details and exam results Date obtained

Professional qualifications please give most recent first Please give details of all qualifications currently held or working towards
Professional body /college/university Dates From To Course details and exam results Date obtained

Specialised training or course attended please give most recent first

Course taken Organised by Location Date

Membership of professional bodies Please give details of membership or any professional duties
Name of professional body Level type of membership Registration details (e.g. UKCC) Expiry date

Supporting Information Please refer to guidance notes

References
Please give details of two professional referees; one must be your current or most recent line manager or school/college. References from family and friends are not acceptable Name Job title Organisation Address Postcode Tel No. Email Name Job title Organisation Address Postcode Tel No. Email

People with a disability or a health condition are entitled by law to 'reasonable adjustments' during the interview process. We are interested in any disability or health condition that may require such a reasonable adjustment. What adjustments do you require in order to attend an interview?

Rethink has a policy of not employing people into a post within the span of control of a manager they are either related to, or in a relationship with. The span of control is that of line manager and line managers manager. Are you related to, or in a relationship with a Rethink manager as defined above?

YES

NO

Disclosure
Due to the nature of the post for which you are applying, it is regarded as exempt from the provisions of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (EXCEPTIONS) (AMENDMENT) ORDER 2001. All applicants must tell us about sentences or convictions that for other purposes would be considered to be spent under the provisions of the Act. In the event of employment, any failure to disclose such sentences or convictions could result in dismissal or other disciplinary action. Any information given will be treated as confidential and considered only in relation to this application. At interview, or in a separate discussion, Rethink will ensure that an open discussion will take place on the subject of any offences or other matters that might be relevant to this vacancy. Applicants who are offered employment or work that involves contact with vulnerable people will be subject to a criminal record check from the Criminal Records Bureau before the appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. Do you have any criminal records to declare? Are there any current proceedings against you? If Yes, please give details below YES YES NO NO

Declarations
Please ensure you sign and date this declaration before returning your application form. DATA PROTECTION ACT DECLARATION The information on the application form will be entered onto a computer system and as such is covered by the rules set out by the Data Protection Act 1998. I declare that the information provided on this form is true and complete to the best of my knowledge and belief. I understand that any false or omitted information may result in dismissal or other disciplinary action if I am appointed. If the form is emailed, we will consider this as a signature.

Signed .. Date

Equal opportunities monitoring

This document will not be considered for short-listing purposes Rethink is committed to the implementation of its Equal Opportunities Policy in all aspects of its work, including the recruitment, promotion and training of staff and the delivery of services. It would assist us greatly if you would complete the monitoring form so that we can monitor the effectiveness of our Equal Opportunities Policy and to find out whether there are any particular minority needs within our workforce. Please return this form even if you do not intend to return your application. Title Surname Date of Birth (Mr/Mrs/Miss/Ms/Dr/Other) Forename Gender Male / Female

Please tick the boxes that you feel most comfortable with. If you do not feel any of the boxes are appropriate, please tick other and describe in your own words. ( ) Cultural Background White British Irish Other White, describe below Asian or Asian British Indian Pakistan Bangladeshi Other Asian, describe below Chinese or Other Ethnic Group Chinese Any other, describe below Black or Black British Caribbean African Other Black, describe below Mixed White and Black Caribbean White and Black African White and Asian Other Mixed, describe below Undisclosed Do not wish to answer

Religion and belief Buddhist Christian Hindu Jewish Muslim Disability and Mental Health Do you consider yourself to have a sensory, learning or physical disability? Do you consider yourself to have a disability related to your mental health? Have you personally used mental health services? Sexual Orientation Heterosexual Lesbian Do not wish to answer Caring Responsibilities Do you look after someone from any of the following groups? A child An adult Someone with a sensory, learning or physical disability Someone with a disability related to his/her mental health Not a carer Do not wish to answer Other, please specify
Have you used carers services?

Sikh No Religious Belief Do not wish to answer Other religion/belief, describe below

YES NO YES NO YES NO

Homosexual Bisexual

Further information
For further information about why Rethink collects this information, please see the staff website for a copy of the Guidance on Equal Opportunities Monitoring or call the Personnel Team

Data protection
The information will be kept in a database in accordance with the provisions of the Data Protection Act 1998 (which allows for sensitive personal data to be held where necessary to monitor organisations Equal Opportunities Policy). Access to information that identifies individuals will be strictly restricted and used only for implementation of Equal Opportunities policies. Employees have the right to check that information held about them is correct.