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Serving East Anglia, The Home Counties & South East England

Application Form

Confidential Application for Employment-F36

Please fill out the Form below:

Which post are you applying for?

When would you be able to start?

How did you learn of this vacancy?

Do you have pre-booked holidays:

Yes

If yes please state dates:

Personal Details

Title:

Surname:

Fornames:

Address:

Postcode:

Home No:

Mobile:

Email:

N.I number:

Education

Name of School:

	Qualifications	Level	Grade	Date
1	1, Qualifications:	1, Level:	1, Grade:	1, Date:
2	2, Qualifications:	2, Level:	2, Grade:	2, Date:
3	3, Qualifications:	3, Level:	3, Grade:	3, Date:
4	4, Qualifications:	4, Level:	4, Grade:	4, Date:

Further Qualifications & Training

	Course	Institution	Award gained	Date
1	1, Course:	1, Institution:	1, Award gained:	1, Date:
2	2, Course:	2, Institution:	2, Award gained:	2, Date:
3	3, Course:	3, Institution:	3, Award gained:	3, Date:

Employment History

Current/Most recent post

Current Employers Name:

Position Held:

Reason for leaving:

Date Appointed:

Pay on Leaving:

Notice Required:

Previous employers

	Employer	Position Held	Pay on Leaving	Start Date	Date Left	Reason for Leaving
1	1, Employer:	1, Position Held:	1, Pay on Leaving:	1, Start Date:	1, Date Left:	1, Reason for Leaving:
2	2, Employer:	2, Position Held:	2, Pay on Leaving:	2, Start Date:	2, Date Left:	2, Reason for Leaving:
3	3, Employer:	3, Position Held:	3, Pay on Leaving:	3, Start Date:	3, Date Left:	3, Reason for Leaving:
4	4, Employer:	4, Position Held:	4, Pay on Leaving:	4, Start Date:	4, Date Left:	4, Reason for Leaving:

Experience & Skills

Please give any further details to support your application.

What interested you in applying for the position?

What personal qualities do you think will best help you succeed in this position?

Supporting Info:

References

Please give 2 referees; 1 from employer and 1 personal reference.

	Name	Address	Phone
Employer Reference	Employer Reference, Name:	Employer Reference, Address:	Employer Reference, Phone:
Personal Reference	Personal Reference, Name:	Personal Reference, Address:	Personal Reference, Phone:

Referees will not be contacted until after an interview has taken place.

Driving

Do you hold a current driving licence?

Yes

Are there any current & valid points?

Yes

If yes, please detail:

Asylum & Immigration

We are required to check your eligibility for employment in the UK and would therefore ask you to bring your current passport and or alternative right to work documents if you are asked to attend an interview.

Offences and Convictions

Have you ever been convicted of any civil or criminal offence?

Yes

Are there any alleged offences outstanding against you?

Yes

If the answer is yes to either question, please give details below.

NB disclosure is not required where there is a conviction to which the provisions of the Rehabilitation of Offenders Act, 1974 apply. Failure to disclose an unspent conviction is, in itself, a criminal offence. If you are unclear please ask the Interviewer.

Applications Declaration

I understand that the information provided on this application form will remain private and confidential and will be used for the purpose of selection/recruitment. Where the application is successful the organisation may from time to time wish to process this information for personnel administration and business management purposes. Where this is the case processing will take place in accordance with the provisions of the Data Protection Acts 1984 and 1998. By signing this form I am providing the organisation with my consent to all these uses.

I confirm details in this application are correct and complete. I understand that canvassing or giving false information will disqualify my application, or if discovered after appointment may be regarded as grounds for dismissal.

I also understand that appointment will be subject to satisfactory references and evidence of eligibility to work in the UK.

Signed (Type Name):

Date:

EQUAL OPPORTUNITY MONITORING

We are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of race, colour, ethnic or national origin, religious belief, political opinion or affiliation, sex, marital status, sexual orientation, gender reassignment, age or disability, or is disadvantaged by conditions or requirements which cannot be shown to be justifiable.

Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities.

All employees are given equal opportunity and are encouraged to progress within the organisation.

We are committed to an ongoing programme of action to make this policy fully effective. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:

I would describe my ethnic group and sex as: (please tick one box for your ethnic group)

White:

English

Scottish

Welsh

Irish

Any other White background, please specify:

Mixed:

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed background, please specify:

Asian, Asian British, Asian English, Asian Scottish or Asian Welsh:

Indian

Pakistani

Bangladeshi

Any other Asian background, please specify:

Black, Black British, Black English, Black Scottish or Black Welsh:

Caribbean

African

Any other Black background, please specify:

Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh of other Ethnic Group:

Chinese

Any other background, please specify:

Sex:

Male

Female

Upload CV:

Signed (Type Name):

Date:

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