Please enable JavaScript in your browser to complete this form.

Please attempt to answer all relevant questions in full. This information will be used to select candidates for placements.

Name
Address
Have you have lived at this address less than 3 years?
Please list all relevant qualifications completed
Please include the following: Training Provider Name, Name of Course, Address of Course, Course Contact, Name of Tutor, Contact Phone Number(s)
Click or drag files to this area to upload. You can upload up to 10 files.
Please upload any relevant certificates relating to your qualifications or training
Click or drag a file to this area to upload.
(Requirement is for membership to be held for a minimum of 1 year)
Click or drag a file to this area to upload.
I confirm that I will abide by the Ethical Framework and the code of ethics of my chosen organisation as above:
Placement Venue Choice
Availability
Dates, Position/Title, Description of Job Role

References

Name - Referee 1
Address
Name - Referee 2
Address

Additional Information

Are you related to any trustee/current employee/service user?
Do you have a personal or social relationship with any trustee/employee/service user?
Under the Rehabilitation of Offenders Act 1974, all criminal convictions must be disclosed. Failure to do so will result in immediate termination of employment. Do you have any convictions:
If you are applying for a job working directly with clients you should also disclose any spent convictions or cautions, reprimands or final warnings given to you by the police or any other information that may have a bearing on your suitability for this post.

Declaration

The information provided by me, to the best of my knowledge, is correct. I understand that my application will be disqualified, or after appointment, disciplinary action taken, if I have knowingly given false information. I consent to this information being checked by Mind in West Essex and for it to be used during the recruitment process. I understand that in the event of a successful application an enhanced disclosure will be sought from the Disclosure and Barring Service.
Clear Signature

Consent

I give my consent to Mind in West Essex contacting my course tutors and/or supervisors
Clear Signature
Save and Resume Later

Training Academy

Our Training Academy website offers a number of interactive courses to help you learn how to manage your mental health and provide support for others.
 

Learn at your own pace on our Training Academy

Side by Side

Side by Side is a supportive online community where you can be yourself. We all know what it's like to struggle sometimes, but now there's a safe place to listen.

Connect with people who experience struggles at times

Counselling

Our highly qualified therapists have a range of specialities and approaches as we know it is not one size fits all.
 
 

Learn about how counselling can work for you

Accreditations