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1 Application Form Please complete all sections of this application form, including salary expectations, and return to Jessica Dexter, HR and Payroll Officer at by the specified deadline. Section 1 - Personal Details Title: Choose an item. Last Name: First Names: Address: Postcode: Home Telephone Number: Mobile Telephone Number: address: Are you eligible to work in the UK? Yes No Are you prepared to bring passport / work visa and all relevant original qualifications to interview? Yes No! 1

2 Section 2 Education and Training Name of School / College Examinations / Training undertaken or in progress (list most recent first) Section 3 Professional Qualifications & CPS Please list below further professional qualifications, training & CPD including year and Agency! 2

3 ! 3

4 Section 4 Employment Record Name and Address of Employer Click here to enter text. Date From: Date To: Job Title/Job Function/ Responsibilities: Click here to enter text. Click here to enter text. Salary and Reason for Leaving: Click here to enter text.! 4

5 Section 4 Personal Statement Please outline what skills and experience you have which demonstrates your suitability for the post.! 5

6 Section 5 Rehabilitation of Offenders Act EFL Trust Rehabilitation of Offenders policy is included in this application pack. Applications are advised to read the policy carefully. Have you ever been convicted of a criminal offence? Yes No Have you ever been or are you now being investigated by police or any social care agency? Have you ever been the subject of a disciplinary at work or volunteering as a result of a safeguarding complaint? Yes No Yes No If yes, please give details / dates of offence(s) and sentence:! 6

7 Section 6 References Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are (NB. References will only be taken if you are offered the position). Appointment will be subject to the receipt of suitable references. Reference 1 Reference 2 Name: Name: Their Position (job title): Their Position (job title): Work Relationship: Work Relationship: Organisation: Organisation: Dates Employed: From: Click here to enter a date. To: Click here to enter a date. Dates Employed: From: Click here to enter a date. To: Click here to enter a date. Address: Address: Postcode: Postcode: Telephone No: Telephone No: Section 7 Declaration I confirm that the information provided in this application form is truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy and may lead to dismissal. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK, appropriate qualifications, satisfactory references and a probationary period. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file. Signed: Date: Click here to enter a date.! 7

8 EFL undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998.! 8

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