Health in Mind Team

Please express interest below to spend some time with the Health in Mind team. Please provide as much information to help towards your application. Your answers may decide if you are allocated a placement or not.

Please note, if you do not hear from us within two weeks your application has been unsuccessful. Due to the volume of applications we are unable to give feedback.

Thank you.

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* 1. Please enter your full name

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* 2. Please enter your date of birth

Date / Time

Date

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* 3. What is your current occupation?

Qualified Nurse

Doctor

Medical Student

Student (Under 17)

Student (Over 17)

Ambulance staff

Other (please specify)

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* 4. At what email address would you like to be contacted?

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* 5. Can you tell us why you would like to spend time with Health in Mind (Please be specific)

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* 6. How are you hoping time with the team benefits you? (Please briefly explain)

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* 7. Supporting Information

This is your opportunity to tell us a bit about yourself and explain why you would like work experience with the team. Supporting information can be anything that is not already covered elsewhere on the form and may include hobbies and interests you enjoy.

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* 8. When would you like your placement to take place? Please leave blank if unknown (Work experience placements offered are normally one day placements subject to availability)

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* 9. Please confirm that you are aware YOU WILL NOT be able to have any physical contact or be part of any clinical decision making

I am aware that I will not have any physical contact and I will not be involved in any decision making

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* 10. Data protection

As part of the registration process, we will collect the data submitted via this form, which we will process and hold in accordance with the General Data Protection Regulation (GDPR), in force from 25 May 2018. Please tick to indicate your consent for this data to be held and processed by us for the purpose of managing your placement request only.

We will not process your data for any other reason and will not share it with any third
parties. We will hold your data on survey monkey until a maximum of one month after
submission when it will be destroyed.

I agree for my data to be used for the purposes described in this form only

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* 1. Please enter your full name

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* 2. Please enter your date of birth

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* 3. What is your current occupation?

Question Title

* 4. At what email address would you like to be contacted?

Question Title

* 5. Can you tell us why you would like to spend time with Health in Mind (Please be specific)

Question Title

* 6. How are you hoping time with the team benefits you? (Please briefly explain)

Question Title

* 7. Supporting InformationThis is your opportunity to tell us a bit about yourself and explain why you would like work experience with the team. Supporting information can be anything that is not already covered elsewhere on the form and may include hobbies and interests you enjoy.

Question Title

* 8. When would you like your placement to take place? Please leave blank if unknown (Work experience placements offered are normally one day placements subject to availability)

Question Title

* 9. Please confirm that you are aware YOU WILL NOT be able to have any physical contact or be part of any clinical decision making

Question Title

* 7. Supporting Information

This is your opportunity to tell us a bit about yourself and explain why you would like work experience with the team. Supporting information can be anything that is not already covered elsewhere on the form and may include hobbies and interests you enjoy.