APPLICATION FORM. 16 hours per week based at Morpeth. I wish to be considered for both vacancies. address. Number

Transcription

1 APPLICATION FORM Please return the completed application form to: Sue Glennie, HR Manager, Wellway Medical, The Surgery, Wellway, Morpeth, NE61 1BJ or via to Vacancy applied for: (Please tick as appropriate Receptionist Receptionist 16 hours per week based at Lynemouth 16 hours per week based at Morpeth I wish to be considered for both vacancies Personal Details First Names) Title (Mr, Mrs, Miss, Ms.) Home Address Last name: address Home Tel. Number Mobile Tel. Number Qualifications & Training Please detail any qualifications or training you have obtained that are relevant to the post for which you are applying. Subject Grades/Qualifications Date obtained Present Employment (if applicable)

2 End Date (if applicable): Previous Employment over the past 5 years (continue on a separate sheet if necessary) Previous Employment (1) Previous Employment (2) Previous Employment (3) Please tell us why you have applied for this post.

3 Experience, Skills and Knowledge Please enter any additional information that you feel would be relevant to support your application Experience: Skills: Knowledge:

4 REFERENCES Please give the names of the people who have agreed to supply references. You must provide two referees. If you are, or have been employed, these should be your two most recent employers. These may include your line manager or someone in a position of responsibility who can comment on your work experience, competence, personal qualities and suitability for the post. If you are a student please provide contact details of a teacher at your school, college or university. Please note that personal references from friends and relatives are not acceptable. Referees will only be contacted if a provisional offer of employment is made Referee 1 LAST NAME: FIRST NAME: JOB TITLE: ADDRESS: POST CODE: TELEPHONE: FAX: RELATIONSHIP: Referee 2 LAST NAME: FIRST NAME: JOB TITLE: ADDRESS: POST CODE: TELEPHONE: FAX: RELATIONSHIP:

5 Asylum & Immigration Act If you are not a British /EEA Citizen, can you provide documentary evidence that you are eligible to work in the UK? Rehabilitation of Offenders Act Please indicate by an x. You are not required to disclose spent convictions covered by the Rehabilitation of Offenders Act. A conviction becomes spent after a certain length of time, which varies depending upon the sentence and your age at the time of conviction. If you have any doubts about declaring a previous conviction, you should contact your local Probation Office, the Citizens Advice Bureau or your solicitor. Please give details of convictions where applicable Do you have any criminal convictions, which are not spent? Yes: No: If yes, please provide details: Declaration DATA PROTECTION ACT 1998 Information provided by you on this application form may be copied for use during the recruitment procedure. Once the recruitment procedure is completed, the data will be securely stored for six months and then destroyed. If you are successful, relevant information from this application form will be used for your employee record. I confirm that the above information is complete and correct and that any untrue or misleading information will give the company the right to terminate any employment contract offered. I hereby give permission to the company to retain my personal data for the purposes of recruitment as stated above. Signed: Date :