Application Form

If you require this form to be resent to you so that you can fill it in more easily, or for it to be submitted in a different format, please contact the HR manager. Examples are a format in Braille or large print. This will in no way be detrimental to your application. Please complete in BLOCK CAPITALS and in BLACK INK.

1. Application Form

Position applied for

Available to take up employment [Enter date]

2. Prepared to Work

3. Personal Details

First name*

Last name*

Address

Telephone numbers

Private

Work

Mobile

E-mail*

Do you own a car?

Have a current driving licence?

Provisional

Full

HGV

Have you any current endorsements?

If yes, give details

4. Languages

Do you speak or read a foreign language?

If yes, give details

5. Secondary Education

School name/address

Examinations (subject/result, etc)

6. Further Education and Training

University/College

Type of course

Subjects

Qualification or class of degree

7. Occupational Qualifications

College/Institute or other name

Qualification/Level

8. Membership of Professional Body

Name

Level

9. Employment

Present/last employer

Current/previous employment

Start date

End date

Address

Job title

Duties/responsibilities

Reason for leaving

Finishing pay

£/Hour

Other most recent employer

Previous employment

Start date

End date

Address

Duties/responsibilities

Reason for leaving

Finishing pay

£ / hour

10. General

Interests/hobbies (give details of pastimes, sports, etc)

Offices held in social/sports clubs, etc

Public duties (JP, local councillor, etc) undertaken

Do you have any convictions, cautions reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013).

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are “protected” and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service Website.

(Declaration subject to the Rehabilitation of Offenders Act 1974)

If yes, give details

If offered this position will you continue to work in any other capacity?

If yes, give details

11. Permission to Work in the UK

Are there any restrictions to your residence in the UK that might affect your right to take up employment in the UK?

If you are successful in your application would you require permission to work in the UK?

Yes No

12. Community/Volunteer Experience

Name and address of organisation

Position/title

Duties

13. Personal Referees

Work reference — not members of your own family

Name

Address

Organisation

Occupation

Telephone number

E-mail address

Work, personal or educational

Name

Address

Organisation

Occupation

Telephone number

E-mail address

14. Additional Personal Details

Applicants are requested to tick the relevant boxes below to enable the organisation to monitor its equal opportunity policy. Monitoring is recommended by the Codes of Practice for the elimination of racial discrimination and for the elimination of discrimination on the grounds of sex and marital status. This information is used for no other purpose and will be treated as confidential.

National Insurance number

15. Recruitment Policy

It is the organisation's policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, ethnic origin, national origin, sex, sexual orientation, religion or belief, pregnancy, trans-gender status, marital or civil partnership status, age or disability.

I authorise the organisation to obtain references to support this application once an offer has been made and accepted and release the organisation and referees from any liability caused by giving and receiving information.

Declaration

I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement will be sufficient cause for rejection or, if employed, dismissal.

Signature (Enter your Name)

Date

16. For Office Use Only

Starting date

Job offered

Pay

Hours of work

Department/supervisor

Payroll number

Recruitment source

National Insurance number

Proof of right to work in the UK

Yes / No

Detail:

P45 or P46

Yes / No

Reference requested

Yes / No

Driving licence

Proof of qualifications

17. Interviewer’s Use Only (1=very good; 2=good; 3=satisfactory; 4=poor; 5=very poor)

Appearance

Communication

Experience

Co-operation

General Impression

Other Comments

Manager’s Name

Signature/Date

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