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Personal Data capture
MINDSET PERSONAL DETAIL CAPTURE.
THE JOB YOU ARE APPLYING FOR
Job Title
Location:
PERSONAL DETAILS
Surname
Forename(s)
DOB
Town of Birth
Work Phone Number 2
NI
Address
Post Town
County
Post Code
Contact No
Email address
Do you have a disability?(We guarantee to interview people with disabilities who meet the essential requirements of the job.)
Yes No
Yes
No
Have you previously worked for Mindset
yes no
Yes
No
Have you been referred to us by a Mindset employee?
yes no
Yes
No
Are you a relative/partner of anyone employed by Mindset?
yes no
Yes
No
Do you have the right to work in the UK?
yes no
Yes
No
Do you hold a full UK driving licence?
yes no
Yes
No
Are you willing to drive on all types of UK road as part of your role with us?
yes no
Yes
No
Part Time
Part Time
Full Time
Please specify the number of hours (part time only)
What excites you about the role of Support Worker?
Tell us about a time when you have looked after the needs of a customer, or another person?
Please tell us anything about yourself, your interests or your experience, that you feel would make you a good Support Worker?
NEXT OF KIN/EMERGENCY DETAILS.
Name
Address
Postcode
Relationship
Home Phone
Mobile Phone
BANK DETAILS
Name of Bank
Bank Address
Postcode
Account Name
Sort Code
Account Number
NIGHT WORKERS
Years 1-30
Years 1-30
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Month 1-12
Month 1-12
1
2
3
4
5
6
7
8
9
10
11
12
What type of work was this?
Have you ever suffered any health problems?
Signature
Date
Complete
