Positive Action Application Form

Transcription

1 Positive Action Application Form Post applied for: Please complete every section of this form and remember to link your information to the person specification, found on the job description. Please use black ink or type your application. You can the form to us but ask that you ensure we receive it in a readable format. This page, and the equal opportunities monitoring form, will be removed prior to shortlisting of applications. About You Surname: Other Names: Address: Telephone Number(s): address: Are you a UK resident? Do you need permission/ a visa to work in the UK? When are you available to take up the post of you are successful? Do you require any specific facilities to be in place for the interview?

2 Declaration I agree that Positive Action may use the information provided in this application form for monitoring purposes. I agree that Positive Action may ask my referees for comments on my suitability for the post and request details of my attendance, sickness and salary. I also understand that if I am successful I will need to undertake an enhanced disclosure and barring (criminal record) check with a barred list check. In submitting this application form, I confirm that the information I have given is correct and complete and that misleading or untruthful statements will result in my dismissal if they become known after my appointment. Signed: Date: For electronically submitted forms, you will be asked to sign the form if invited to interview. Please explain your motivation for applying for the role and why you wish to work for Positive Action.

3 Please list any previous jobs you have had, beginning with the most recent, and explain any gaps in your employment history. Please also include any voluntary work you have done which you feel is relevant to this application and use additional sheets as necessary. Dates from/to Job title & employer s name and address Key responsibilities Salary on leaving

4 Please provide evidence of your skills and knowledge capabilities against the person specification. Please structure your examples using bullet points, providing specific examples from your professional and / or voluntary experience. Please use additional sheets as necessary.

5 Please tell us about any qualifications you have. School/ college/ other Qualification Level Subject(s) If you wish, please add any further information that you would like us to consider in support of your application. Additionally, please use this section to highlight any difficulties you may have experienced in completing this form so that we are able to take this into account during the shortlisting process.

6 References Please give us the names, addresses and telephone numbers of two people, including your current or latest employer who would be willing and able to be contacted to verify the information you have given and to let us know their assessment of your ability to carry out this job. Please indicate if you would like us to contact you first before we contact these references. Referee One Name: Job title: Address: Referee Two Name: Job title: Address: Tel: (if any) Tel: (if any) Can we contact this person prior to interview? YES/NO Can we contact this person prior to interview? YES/NO Please note that this role is subject to an enhanced disclosure and barring (criminal record) check with a barred list check. Have you any unspent criminal convictions in line with the Rehabilitation of Offenders Act 1974 (see the following page for more information)? Yes / No If yes, please provide information, below.

7 Rehabilitation of Offenders Act 1974 The Rehabilitation of Offenders Act 1974 is intended to ensure that a person convicted of a criminal offence (whether in Great Britain or abroad), not involving a sentence of more than 2.5 years imprisonment who has not since re-offended for a specified period of time (a rehabilitation period) related to the severity of their sentence is treated as if the offence, conviction and sentence had never occurred. Sentences of more than 2.5 years put an individual concerned outside the scope of the Act. Such convictions can never therefore become spent. (Exceptions) (Amendment) order 1986 Exempted professions NOT covered by The Rehabilitation of Offenders Act 1974 are: Medical practitioner Barrister (in England and Wales), advocate (in Scotland), solicitor; Chartered accountant, certified accountant; Dentist, dental hygienist, dental auxiliary; Veterinary surgeon; Nurse, midwife; Ophthalmic optician, dispensing optician; Pharmaceutical chemist; Registered teacher (in Scotland); Any profession to which the Professions Supplementary to Medicine Act 1960 applies and which is undertaken following registration under the Act

8 Equal Opportunities Monitoring Form The information submitted on this form is treated in the strictest confidence and is used for monitoring purposes only. The information will be stored either on paper records or a computer system in accordance with the Data Protection Act 1998 and will be used solely to monitor the equality and diversity of Positive Action s recruitment. You may choose to return this form with your application form, in which case it will be removed before shortlisting occurs, or you may wish to send it under separate cover. You may also choose not to answer certain questions, however all information you can share with us is very useful to ensure we are achieving equality and diversity within our recruitment procedures. Post applied for Gender Male Female Transgender Do not wish to disclose Ethnic Group (please tick appropriate box) White White British White Irish White any other white background Mixed White and black Caribbean White and black African White and Asian Any other mixed background Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background Black or Black British African Caribbean Any other black

9 Chinese or other Ethnic Group Chinese Any other please write in Do not wish to disclose Sexual Orientation Gay Lesbian Bisexual Heterosexual Do not wish to disclose Age Date of Birth Do not wish to disclose Do you consider yourself to be disabled under the Disability Discrimination Act? (The Disability Discrimination Act defines disability as a physical or mental impairment which has a substantial and adverse effect on a person s ability to carry out day to day activities.) Yes No Do not wish to disclose Where did you hear about the vacancy? If you give permission, we will collate this information anonymously to monitor equality and diversity in our recruitment and may share with our funders. This form will be stored separately from your application form. Please tick the box if you agree to this information being collated and shared with funders. Thank you for sharing this information.