Thank you for your interest in becoming a trainee within our social enterprise, we would like to invite you to complete this application as thoroughly as you can.

Which project are you interested in?:

How did you hear about us?:


Date of Birth (Please enter as dd/mm/yyyy):
Gender - self description:

Current Address

Please be aware that we can currently offer funded trainee placements to residents of Hackney, the City of London and Tower Hamlets.
If you live outside of these boroughs we may ask you to secure funding to be able to offer you a placement. Do you currently have access to or are you able to explore access to funding:

If yes, please indicate details of the funding:

We require the details of a person to contact in case of emergency as well as GP details.

Emergency contact details
What is your relationship to them?
Phone Number:

GP details

GP Surgery:
GP Name :
Referee details

In order for us to process your application we need you to supply the details of someone who has recently been supporting or working with you and that we can contact for further information.

First Name:
Last Name:
Referee Organisation and Department:
What is your relationship to them?
Referee Address:
Referee Phone number:
Referee E-mail:


Have you ever been admitted to hospital experiencing mental distress? :
Please give us some details about your hospitalisation(s):
Have you ever been diagnosed with a mental illness?
If yes, what was the diagnosis?
Are you currently taking any medication?
If yes, please indicate the medication(s) you are taking
Can you describe your current mental health and how you manage it?


Please indicate your current employment status:
Please tell us about any past work that you have done?


Placements are 1 day per week from 10am to 4pm

Please select which days you are available (hold down control to select more than one option):


What are you looking to get out of the placement?

Job skills:
Increase Stability / Develop Routine:
Improve Confidence:
Social Skills:
If you have further expectations about the placement, please provide details:
Do you consider yourself to have any disability?
If yes, please give details:
Do you have any audio or visual impairment or mobility issues?
If yes, please give details:
Do you have any other support needs?
If yes, please give details:

***This section is optional however by providing us with this information you will help us ensure that our services reach the widest possible audiences and that they are available to sections of the public that may be underrepresented. ***

Ethnic Category- Other:

Religion or Belief:
Other Religion or Belief:
Sexual Orientation:
Other Sexual Orientation:


Type your name to confirm that you wish to apply for a trainee placement with The Centre for Better Health