JOB REFERENCE:
Imagine
APPLICATION DETAILS
Position applied for:
Employment
Application Form
Where did you see this vacancy advertised?
If appointed when could you start work?
PERSONAL DETAILS
Thank you for applying for a post with Imagine.
You may already know us, but we thought you
might be interested in some more detail.
Imagine is a leading mental health charity that has
services based in North West England and
London. Our services were started in the 1970’s
pioneering accommodation and social support.
Today over 1000 people use our services and
Imagine now employs over 200 staff and is
fortunate to have the support of many volunteers.
Imagine’s Services include:
 Providing quality housing
 24 hr support schemes
 Floating support
 Working closely with a number of housing
associations
 Training – offering basic skills, ICT, etc
 Supporting choice – enhancing users
opportunities
 Mainstream – promoting social inclusion
 Befriending – volunteers offering low level
support to service users
 Mental Health Awareness
 Chinese Support Service – supporting service
users and carers
Please visit our web site:
www.imaginementalhealth.org.uk
for further information.
Surname:
First Name:
Title:
Address:
Postcode:
Email:
Home:
Mobile:
Work:
(If we may contact you at work)
If shortlisted for interview do you have any support needs? (If yes, please give details e.g. provision of a hearing loop,
signing interpreter, wheelchair access etc.)
Are there any restrictions regarding your employment? (If yes, please give details e.g. do you require a work permit.)
If offered this post will you continue to work in any other capacity? (If yes, please give details)
EDUCATION DETAILS - from Secondary Education. Include academic, vocational and professional
Guidance Notes for completing the
Application Form.
qualifications
Dates from/to
School, College, University etc
Qualifications gained - including grades
In accordance with our Equal Opportunities
Policy it is our aim to appoint the best
candidate for every vacancy in the
organisation. To do this fairly, we need all
applicants to provide relevant information
about themselves.
Please complete all sections of the
application form. If any section does not
apply to you, enter not applicable (N/A).
In the “Supporting Information” section of the
form draw particular attention to experience,
skills, achievements and knowledge gained in
past employment or other activities which are
relevant to the job. Write in a concise, well
organised and positive way giving examples of
how you meet the criteria on the Person
Specification. Please do not repeat your career
history – use only relevant criteria.
CV’s will not be accepted under any
circumstances.
TRAINING - Please list any training you have received which did not lead to a qualification but which you feel are
relevant to the post for which you are applying. Continue on a separate sheet if necessary
.
PRESENT EMPLOYMENT
Job Title:
Date Commenced:
Employers Name and Address:
Current Salary:
Reason for Leaving:
Main duties and responsibilities of your present/most recent job:
PREVIOUS EMPLOYMENT - Most recent employer first (Please account for any gaps in employment and give the reasons why)
Dates
From
To
Employer name and address
Position held
Reason for leaving
SUPPORTING INFORMATION
Please give your reasons for applying. Explain how your experience, skills and training are relevant to the post for which you are applying. Please
make close reference to the Person Specification. Please provide any additional information which you feel is relevant to your application. Also let us
know about any experience gained through voluntary activities which may be relevant to this job. Continue on a separate sheet if necessary – up to a
maximum of 1 additional A4 sheet.
REHABILITATION OF OFFENDERS ACT 1974
If you are applying for a post connected with the provision of support services to adults PLEASE NOTE that, because of the nature of work, such
employment is exempt from the provisions of Sections 4 (2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act
(Exemption) Act 1975. Applicants are therefore not entitled to withhold information relating to convictions, reprimands, cautions or warnings which for
other purposes are “spent” under the provisions of the Act. Any failure to disclose such convictions and, of course, any other convictions, could, if the
applicant is given employment, result in dismissal or disciplinary action. Further information about the disclosure scheme can be found at
www.disclosures.co.uk
o you Do you have a criminal conviction, spent or otherwise?
YES
NO
If yes, please provide details on a separate piece of paper, marked ‘PRIVATE & CONFIDENTIAL and post to Director of Corporate Services, 25 Hope
Street, Liverpool L1 9BQ. Only relevant information will be taken into account so disclosure will not necessarily bar employment with us and will be kept
strictly private and confidential.
REFERENCES
Please give the names and addresses of two referees, one of whom must be your present or most recent employer. If you have not had
any previous employment, the name of a tutor is acceptable; however relatives will not be accepted. References for shortlisted
applicants may be taken up prior to interview.
Reference 1
Reference 2
Name:
Name:
Address:
Address:
Postcode:
Postcode:
Capacity in which known to you:
Capacity in which known to you:
Email:
Email:
Telephone No:
Telephone No:
Fax No:
Fax No:
May we contact referee prior to interview?
Yes
No
May we contact referee prior to interview?
Yes
No
FUTURE VACANCIES WITH IMAGINE
In the event that your application is shortlisted but subsequently unsuccessful, Imagine would like to retain your contact details on file for a maximum of 6
months for the purpose of notifying you of any future vacancies.
I agree
do not agree
Please notify me of any vacancies via
to Imagine retaining my contact details for this purpose.
my email
or home address
DECLARATION
1. I am/am not* related (legally or in common law) to any employee, volunteer, service user of Imagine or board member. *Please delete as
appropriate and note that a positive response will not necessarily prevent you from being employed by Imagine. Full details of our Personal
Relationships Policy is available on request.
2. I acknowledge that an appointment, if offered will be subject to satisfactory medical clearance/references/compliance with the Asylum &
Immigration Act and police clearance where applicable.
3. I declare that the information given on this form is correct and understand that any misleading statements or deliberate omissions will result
in dismissal if they subsequently come to light.
4. I acknowledge that any information submitted in pursuit of my application may be held on computer and therefore falls within the provisions
of the Data Protection Act.
Signature:
Date:
THANK YOU FOR PROVIDING THIS INFORMATION.
PLEASE RETURN THIS COMPLETED APPLICATION FORM TO THE ADDRESS STATED IN THE COVERING LETTER.
COMPANY REGISTERED IN ENGLAND NO: 2699682
REGISTERED CHARITY NO: 1010203
Equal Opportunities in Recruitment
It is the policy of the Organisation to provide equal opportunities in all of its activities. In recruiting staff, all decisions will be made with to the regards of
the requirement of the post and will not be influenced by any consideration of race, colour, creed, ethnic or national origin, age, sex, sexuality, marital
status or responsibility for children or dependents. We aim to eliminate possibilities of bias when considering applications. In order to enable us to
regularly monitor and assess whether equality of opportunity is being achieved, we ask you to complete this form which will be separated from your job
application and will be used for statistical monitoring only. Your responses will not be made known to any of the selection panel and will be kept
separately from your application. Thank you for you co-operation.
(This information will be held on computer and will be subject to the provisions of the Data Protection Act 1998)
Post applied for:
Ref Number:
Nationality:
Gender:
M/F
Date of Birth:
This section is to help us monitor the effectiveness of where we advertise - where did you see this vacancy advertised?

Other (specify)
Newspaper (specify)
Job centre (specify)
Website (specify)
Word of mouth
I would describe my ethnic origin as: (please put an x in the applicable box – cross one box only)
WHITE
MIXED
BRITISH
WHITE & BLACK CARIBBEAN
ASIAN or
ASIAN BRITISH
BLACK or
BLACK
BRITISH
CHINESE or
Other Ethnic
Group
IRISH
OTHER
WHITE & BLACK AFRICAN
WHITE & ASIAN AFRICAN
OTHER
INDIAN
PAKISTANI
BANGLADESHI
CARIBBEAN
AFRICAN
OTHER
CHINESE
OTHER
REFUSED
OTHER
if you have ticked OTHER please describe
Do you consider yourself to have special needs or to be disabled
YES/NO
This information is sought under the Disability Discrimination Act 1996 and enables Imagine to ensure compliance with the Act and its own internal equal opportunities
policy.
If yes, please give details
Equal Opportunities Statement
Policy Statement
We are committed to the principle of equal opportunities. We will make every effort to ensure that no applicants for housing or employment, tenants, members or
employees, receive less favourable treatment than another because of their race, age, colour, ethnic or national origin or because of their religion, sex, disability,
appearance, sexuality, responsibility for dependants, marital status, or because they are HIV positive. We are opposed to any discriminatory practices and attitudes
relating to race, sex or disability and are committed to tackling them all in all aspects of our work. In carrying out our Equal Opportunities Policy we will:
-
abide by the Race Relations Act (1976), the Sex Discrimination Act (1975) and the Disability Discrimination Act (1995) and do our best to implement the
recommendations of the Race Relations Code of Practice in Employment, and Sex Discrimination Code of Practice in Employment.
make every effort to attract people of all groups, either to work for the Society, to act as volunteers, or to be housed by us
in strictest confidence, collect and monitor data on sex, age, ethnic origin and disability of all those applying to us for housing and employment
ensure that all staff and volunteers act in a way which is consistent with our Equal Opportunities Policy
take seriously and investigate urgently any alleged discrimination
ensure that all employees, volunteers and committee members are committed to and actively promote the policy
regularly review and evaluate our practices and set objectives and priorities
ensure that our services are relevant, attractive and accessible to all that use them.
Seek to ensure that our committee reflect our commitment to equal opportunities in both their composition and methods of operation
Staff Recruitment and Development
We are committed to developing and maintaining working environments and practices which will ensure an equality of opportunity in both the recruitment and
development of staff. Discriminatory attitudes or behaviour are unacceptable at any time. Recruitment procedures and practices will be monitored to ensure proper
operation. No employee or job applicant will be disadvantaged by unnecessary conditions, qualifications or requirements. In implementing our employment, recruitment
and training policies we will:
-
monitor recruitment procedures and employment practices to ensure that applicants are considered solely on the basis of merit and ability
ensure that staff and volunteers have an equal opportunity to progress, including the opportunity to develop their full professional potential
require all staff to ensure that their personal conduct is consistent with our Equal Opportunities Policy
provide training on equal opportunities for all staff, volunteers and committee members
regularly review all employment, recruitment and training practices to ensure that we are complying with our objectives.
Monitoring and Target Setting
We will monitor annually the records kept and the policies operated in relation to equal opportunities. Policies and targets will be regularly reviewed and set by our
Board.
Complaints
Individuals who consider that they have been the victims of harassment relating to race, sex or disability have a right to legal proceedings and, if their complaint is
upheld, will be entitled to compensation as appropriate. Help and advice can be obtained from either the Commission for Racial Equal Opportunities Commission,
depending on the nature of the case. Complaints about discrimination will be investigated by a senior manager.