Mindset Mentor Application Form

Please complete all sections on this form. If any sections do not apply to you, please enter 'not applicable'. The information provided on the form will be considered by the short-listing panel who decide whether you proceed to thenext stage of the selection process.

Which Franchise Area are you applying to work within? *

Which position are you applying for? *

First Name *

Last Name *

Address

City

Postal code

Email *

Phone *

Previous Name(s) *

Present or most recent employment

Company/School *

Start Date *

End date / Period of notice *

Reason for leaving *

Description of key duties and responsibilities *

Previous experience working with children (if any).

Please give details of all previous positions you have held since leaving school, that have involved working with children, starting with the most recent.

Information required: Name of School/Nursery/Setting, Type of Setting (No. on roll and age range), Post Held, Reason for Leaving, Date from & to *

Previous other employment

Information required: Name of Employer, Post Held, Reason for Leaving, Date from & to *

Details of any gaps in your employment history *

Relevant skills and experience

Please use this space below to explain why you are applying for the position of Mindset Mentor and how your experience, personal qualities and skills help to make you a suitable candidate. It is essential that you provide us with details that demonstrate how you meet the criteria for knowledge and experience, technical skills and personal/behavioural attributes on the person specification. You must demonstrate you meet all the essential criteria on the person specification as a minimum. This will help us decide whether to invite you to the next stage of the selection process.

Relevant Skills & Experience *

Qualifications - include type, level and dates *

Training & Development - undertaken in the last 3 years that are relevant to the role of a Mindset Mentor *

Criminal Convictions

Tick the box to indicate 'YES' to: Have you ever been convicted of a criminal conviction?

Tick the box to indicate 'YES' to: Is the offence defined by the Rehabilitation of Offenders Act 1974?

Tick the box to indicate 'YES' to: Do you have a criminal conviction which is unspent?

Tick the box to indicate 'YES' to: Do you have a criminal offence pending against you?

Are you related to, or have close relationship with, anyone that works with or for MiniMe Mindfulness®? If YES, please provide details of their name, title and your relationship with them. *

Add any information (medical or otherwise) current, future or in the past 5 years that may hinder your ability to perform the role of a Mindset Mentor with MiniMe Mindfulness® within the defined territory that you are applying to work with.

References

Please give details of two referees, one of whom must be your present and/or last employer and the other from a previous employer. Both referees should ideally be senior people in the organisation.

In the case of applicants leaving full time education or not having worked since doing so, the Head of School, College or University should be one of the named referees. We do not accept references from friends or family members.

Referee 1 (current or previous employer): Information required; Name, Address, Telephone number, Email address, Occupation, Relationship to you. *

Referee 2: Information required; Name, Address, Telephone number, Email address, Occupation, Relationship to you. *

Next of Kin Details: Name, Address, Email, Phone & Relationship to You. *

Contract Witness Name:

Contract Witness Email Address:

Declaration: *

I confirm that I am not included on the (ISA List 99) of people formally barred from working in schools, disqualified from working with children, or subject to sanctions imposed by a regulatory body. I certify that the information given by me on this Application Form is true to the best of my knowledge and I understand that if I am appointed and such information is subsequently found to be materially incorrect, MiniMe Mindfulness® will be entitled to terminate any contracts of agreements without notice.

Signature *

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