Support Worker Application Form

 

Personal details.

Your details will be processed in accordance with the Data Protection Act.

Surname :

First Name :
Date Of Birth :
Telephone Number:
Address:
Town:
Postcode:
Email:

 
Do you hold a full UK driving licence?

Yes

No

 

Employment Details

 

Last/present employer first. Please give full employment History.

Type or name of employment Name of employer From To

 

Qualifications

 

Please state your qualifications. Most recent qualifications first.

Qualification Name of examining body Date Obtained Obtained where

 

Other training

 

Please give details of any other training or development.

Description Date Where Obtained

 

What makes you a good candidate for this position?
Please give details of any experience/qualifications that may be relevant to the post.

 

 

References

 

Please detail below two referees including your last or present employer.

Name of Employer Address Telephone
     

Please give details of the number of hours you are available to work. e.g 7-9 Monday-Sunday.

 

Personal Health Statement

 

Forname

Surname

D.O.B

 

Are you suffering from a mental or physical condition, for which you have consulted a member of the medical profession recently?

Yes

No

 

If yes, please give details of condition and current treatment if any.

 

On the basis of the information given above I consider myself to be physically and mentally fit for the post of community mental health support worker.

 

 


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