FOR OFFICE USE ONLY / Candidate No:

Job Application

Regional Health and Wellbeing Case Managers

REF: RCM01/17

Applicants must complete the application form in either Arial font size 12, or legible block capitals using black ink.

Closing date for applications – 17:00 on Friday 10 February 2017

  1. DECLARATION

  • I have read and understood the information provided in the Candidate Information Booklet.
  • I undertake to inform the Victims and Survivors Service in writing of any changes in my circumstances which may occur between the date of my application and any possible date of appointment.
  • The responses detailed in this application form are true and accurate to the best of my knowledge and belief. I understand that if I am found to have suppressed any material fact or to have given false answers I will be liable to disqualification or, if appointed, to dismissal.
  • I confirm I am aged 16 or over.
  • I give my consent for a criminal record check to be carried out as detailed in the ‘Vetting’ section of the Candidate Information Booklet.

Signed:Date:

JOB APPLICATION FORM

POSITION APPLIED FOR:
Job Title:Regional Health and Wellbeing Case Managers
Ref No: RCM01/17
Where did you see this post advertised?
  1. APPLICANT DETAILS

Title / Surname / Forename
Home Address
Postcode:
Contact Details
Daytime no:
Evening no:
Mobile no:
Email address:
National Insurance No:
Town of birth:
Country of birth:
Do you hold a current driving licence? / Yes / No:
How much notice do you need to give your current employer?
  1. EMPLOYMENT RECORD

Please start with your most recent employer.

Employer Name:
Address:
Job Title: / From:/ / / To:/ /
Brief description of duties:
Reason for leaving / changing:
Employer Name:
Address:
Job Title: / From:/ / / To:/ /
Brief description of duties:
Reason for leaving / changing:
Employer Name:
Address:
Job Title: / From:/ / / To:/ /
Brief description of duties:
Reason for leaving / changing:
Employer Name:
Address:
Job Title: / From:/ / / To:/ /
Brief description of duties:
Reason for leaving / changing:
Employer Name:
Address:
Job Title: / From:/ / / To:/ /
Brief description of duties:
Reason for leaving / changing:
Employer Name:
Address:
Job Title: / From:/ / / To:/ /
Brief description of duties:
Reason for leaving / changing:
  1. EDUCATION :

Name of school/ college / Qualification / Level / Subject / Grade Awarded / Date Gained
  1. FURTHER / HIGHER EDUCATION:

Include information on undergraduate and postgraduate degrees, diplomas, evening and correspondence courses, vocational or technical courses.

Name of University/College / Qualification / Level / Subject / Grade /Classification Awarded / Date Gained
  1. PROFESSIONAL MEMBERSHIPS

Please provide details of any professional memberships you hold.
  1. LOCATION

The VSS intends to appoint 5 candidates from this competition. Each Case Manager will be responsible for covering one of the geographical areas listed below.

Please indicate the geographical area in which you would prefer to cover by ranking the areas from 1 – 5 (with 1 being your preferred geographical area):

Geographical Areas* / Rank
Belfast
South Eastern
Northern
Southern
Western

*further details can be found in the Candidate Information Booklet

  1. ESSENTIAL ELIGIBILITY CRITERIA

By the closing date for applications, candidates must be able to demonstrate all essential eligibility criteria.

8.1) Please outline the qualification(s) you hold as listed inEssential Criteria 1 of Candidate Information Booklet?
Yes No
Please provide details of the type of qualification, the awarding body,grade achieved, and the date gained. If you feel the qualification is an equivalent, list the
modules studied.
8.2)Do you have a minimum of 3 years’ supervised post-qualifying experience gained within the last 6 years working in the field of mental health, 1 year of which must be within the field of trauma?
Yes No
Please provide full details of this experience to include what your role was, the dates when experience was gained and what you were responsible for.
8.3) Please outline the accreditation you hold with a professional body,as identified in the Candidate Information Booklet?
Please provide details of the type of accreditation, the professional body and the level of accreditation, where appropriate.
8.4)Please outline your practical experience of working with Conflict/Troubles-related mental health issues e.g. PTSD, multiple complex traumas, dissociation, etc?
Yes No
Please provide full details of this experience to include what your role was, the dates when experience was gained and what you were responsible for.
8.5) Do you have a minimum of 3 years’ experience in building constructive and collaborative working relationships in a multi-disciplinary/multi-agency environment to meet client needs?
Yes No
Please provide full details of this experience to include what your role was, the dates when knowledge/experience was gained and what you were responsible for.
8.6) Please demonstrate your practical experience of evidence based practice guidelines for treatment, as outlined by the National Institute for Health and Clinical Excellence (NICE)?
Yes No
Please provide full details of this experience to include what your role was, the dates when knowledge/experience was gained and what you were responsible for.
  1. SHORT-LISTING / DESIRABLE CRITERIA

Should it be necessary to shortlist candidates to go forward to interview the following short-listing criteria will be used:

9.1) Do you have experience of managing a budget?
Yes No
Please provide full details of this experience to include what your role was, the dates when knowledge/experience was gained and what you were responsible for and the value of budget held.
9.2) Do you have experience of delivering presentations or training to various organisations?
Yes No
Please provide full details of this experience to include what your role was, the dates when experience was gained and what you were responsible for.
  1. SPECIAL REQUIREMENTS

As an Equal Opportunity Employer we wish to ensure that all applicants have the opportunity to perform to the best of their ability in either a test or interview situation.

Please let us know if you require any reasonable adjustments, or arrangements to enable you to attend for interview.

Please send this completed application form to:

Recruitment Officer

Victims and Survivors Service

1st Floor Seatem House

28-32 Alfred Street

Belfast

BT2 8EN

Your application must be received no later than: 17:00 on 10February 2017.

PLEASE COMPLETE THE EQUAL OPPORTUNTIES MONITORING FORM ON THE FOLLOWING TWO PAGES AND RETURN IN THE SEPARATE ENVELOPE INCLUDED IN THE APPLICATION PACK. FAILURE TO COMPLETE AND RETURN IT WILL RESULT IN DISQUALIFICATION.

IN CONFIDENCE

  1. EQUAL OPPORTUNITIES MONITORING

(RETURN WITH YOUR APPLICATION FORM)

PLEASE NOTE THIS FORM IS REGARDED AS PART OF YOUR APPLICATION FORM AND FAILURE TO COMPLETE AND RETURN IT WILL RESULT IN DISQUALIFICATION.

Please ensure that you read the notes for guidance in the Candidate Information Booklet before you complete this part of your application form.

JOB TITLE:Regional Health and Wellbeing Case Managers / Ref:RCM01/17

It is the policy of the Victims and Survivors Service (VSS) to ensure that all eligible persons have equal opportunity for employment and advancement inVSS on the basis of their ability, qualifications and aptitude. VSS selects those suitable for appointment solely on the basis of merit without regard to an individual’s disability, race, religion or sex. Monitoring is carried out to ensure that the equal opportunity policy of the VSS is effectively implemented.

Please select as appropriate: / MALE / FEMALE
National Insurance Number:
Date of Birth:

COMMUNITY BACKGROUND

The Fair Employment and Treatment (Northern Ireland) Order 1998 outlaws discrimination on the basis of religious belief or political opinion. The information below is required in connection with the requirements of the above Order. The use and confidentiality of Community Background information is protected by the Fair Employment and Treatment (Northern Ireland) Order 1998. It will be used only for monitoring the effectiveness of the VSS’s equal opportunity policy and to comply with obligations relating to the monitoring, investigations or proceeding under the requirements of the Fair Employment and Treatment (Northern Ireland) Order 1998.

Please indicate your community background by ticking the appropriate box below:

I have a Protestant community background
I have a Roman Catholic community background
I have neither a Protestant nor a Roman Catholic community background

RACE – The Race Relations (Northern Ireland) Order 1997 makes it unlawful to discriminate in employment on the grounds of colour, race, nationality or ethnic or national origins. VSS monitors its workforce in line with recommended good practice.

RACIAL MONITORING – PART A (You must indicate by ticking one of the boxes below)

Are you: / White / Of Black African origin
Of Black Caribbean origin / Of Bangladeshi origin
Of Chinese origin / Of Indian origin
Of Pakistani origin / Of other origin (please specify)
______

RACIAL MONITORING PART B(You must answer both of the following questions)

Are you a member of a mixed ethnic group? / Yes / No
Are you a member of the Irish Traveller Community / Yes / No

DISABILITY– The Disability Discrimination Act 1995 makes it unlawful for an employer to treat a disabled person less favourably than someone else because of their disability, unless there is a good reason. Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has a physical or mental impairment which has substantial and long-term adverse effect on his/her ability to carry out normal day to day activities. Please note that it is the effect of the impairment, without treatment, which determines if an individual meets this definition of disability. Do you consider that you meet this definition of disability?

Do you consider yourself to have a disability? / Yes / No

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