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Surrey Adult Mental Health Alliance

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Apply for a vacancy

Job Application

If you are interested in applying for one of our vacancies, please fill in the form below:

Role you are applying for(Required)

1. PERSONAL DETAILS

Title

Mr

Mrs

Miss

Ms

Other

Name

First Last

Address

Street Address Address Line 2 City County Postal Code

Home Telephone Number

Email

Do you have any previous criminal convictions, police cautions or any criminal case pending?

Yes

No

If YES please give details

The successful candidate will be required to complete an enhanced Disclosure and Barring Service application (DBS check) for this role.

Do you hold a current Driving Licence

Yes

No

Do you own/ have use of a car?

Yes

No

If you do not drive and/or do not have a car please describe how you will travel to fulfil the requirements of the role:

Do you require a permit to work in the UK

Yes

No

If YES, please give details:

(In accordance with the Asylum and Immigration Act 1996, sec. 8, all new employees must provide documentary evidence of entitlement to work in the UK)

If selected, when could you start? Give period of notice (if applicable)

2. EDUCATION AND QUALIFICATIONS

Secondary Education (e.g. GCSE)

Name of School/ College

Qualifications Gained

Date

Name of School/ College

Qualifications Gained

Date

Further Education (e.g. A Levels and Higher Education)

Name of College/Uni

Qualifications Gained

Grade/Class

Date

Name of College/Uni

Qualifications Gained

Grade/Class

Date

Name of College/Uni

Qualifications Gained

Grade/Class

Date

EMPLOYMENT

Please give details of Current or most recent Employer

Name of Employer

Type of Organisation

Job Title

Date of employment (From)

Month

Day

Year

Date of employment (To)

Month

Day

Year

Current Salary

Reason for leaving:

Outline your Responsibilities:

What have you enjoyed most whilst in this Role?

Please provide details of previous employers

Name:

Dates (From – To):

Position held and reason for leaving:

Name:

Dates (From – To):

Position held and reason for leaving:

Name:

Dates (From – To):

Position held and reason for leaving:

Name:

Dates (From – To):

Position held and reason for leaving:

4. EXPERIENCE, SKILLS AND INTERESTS

Please tell us more about yourself, your knowledge, experience and skills and any relevant interests.

Please include the following information: How you feel you meet the requirements of the job (see job description and person specification) Why you are applying for this post and what interests you about this job Any relevant experience gained either at work or in any other way What you feel you could bring to this job You can use experience and knowledge from voluntary work and any other activities relevant to this job, as well as previous employment.

If you have any experiences, either professional or personnel, of people with any impairments, (disabilities) or unpaid/family carers please give details.

Referees

Please give the names and addresses of two referees – one must be from your present or most recent employer. These should be professional referees who have known you either at work in a voluntary role or at school or college.

Referee 1

Name

Occupation

Address

Street Address Address Line 2 City County Postal Code Country

Phone

Email

Relationship to Referee

Referee 2

Name

Occupation

Address

Street Address Address Line 2 City County Postal Code Country

Phone

Email

Relationship to Referees

Can we contact these referees without your prior permission?

Yes

No

The question below is not used as part of our shortlisting criteria. It is included to allow us to explore any reasonable adjustments required for the interview process.

Do you consider yourself to be Disabled?

Yes

No

If YES, are there any adjustments that you would like us to make to the interview process should your application be shortlisted?

A person has a disability under the Disability Discrimination Act 1995 and Equality Act 2010 if he/she has a physical, learning or mental impairment or health condition, which has a substantial and long term, adverse effect on his/her ability to carry out normal day to day activities. Long term means has lasted or is expected to last for 12 months.

Where did you hear about the role?

Declaration

I declare that the details given on this application form are to the best of my knowledge and belief, true and complete. I understand that deliberately giving false statements and/ or canvassing the staff or Board Directors of Surrey Coalition of Disabled People would disqualify me from consideration or, in the event of appointment, make me liable to dismissal.
I consent to data contained on this application being processed in accordance with the General Data Protection Regulation 2018

I confirm the above declaration

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Contact Information

Address

Surrey Coalition of Disabled People
Astolat, Coniers Way
Burpham, GU4 7HL

Email

info@surreycoalition.org.uk

Call or text

Tel: 01483 456558

Text: 07908671402

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Registered Charity Number: 1206289
Registered address: Astolat, Coniers Way, Burpham, Guildford GU4 7HL
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