Application Form
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1.
Personal |
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Title |
Forename(s) |
Surname |
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Address |
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Preferred
telephone number |
Email |
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2.
Present or most recent
employment |
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Employer�s name |
Telephone
number |
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Address |
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Date from |
Date to |
Salary |
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Job title |
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Brief
description of main tasks & responsibilities |
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Reason for
seeking alternative employment |
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3.
Start date |
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If appointed,
when would you be able to start? |
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4.
Previous employment |
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Please
list all previous employment (last 10 years) beginning with the most recent
first. Use a separate page if necessary |
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Dates
(from & to) |
Employer�s
name |
Jon
title & brief description of main tasks |
Salary |
Reason
for leaving |
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5.
Training & Education |
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Please
outline what formal education, vocational or professional qualification &
short course training you have undertaken which are relevant to the post |
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Dates (from
& to) |
Examinations,
qualifications or training courses |
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6.
Voluntary Work |
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Please
outline any voluntary work you have done in the past or are involved in
currently which is relevant to the post. |
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Dates (from
& to) |
Organisation�s
name |
Brief
description of main tasks |
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7.
Personal statement |
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What
relevant skills, abilities & experience could you bring to the post &
why do you consider yourself suitable? |
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8.
General Information |
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Is
there any special provision which you require to ensure you require a fair
selection interview? |
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9.
Rehabilitation of Offenders
Act 1974 |
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Disclosure
will require you to disclose any criminal convictions found against you
including convictions, which for other purposes are considered �spent� under
the provisions of the Act. This should also include any cautions, warnings
etc. Further information about The Disclosure scheme can be found at
www.disclosure.gov.uk. |
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Have
you ever been convicted of any criminal offence? |
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Yes�� |
No |
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If
yes please provide details in the box below: |
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Dates
& comments: |
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10 Supplementary information (please tick as appropriate) |
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1.
Are
there any restrictions on your employment in the UK? |
Yes |
No |
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2.
Do
you have permission to work in the UK? |
Yes |
No |
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3.
Do
you need a work permit to work in the UK? |
Yes |
No |
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If
you are not a British nationality, please provide details of your leave
status in the UK (type of visa & expiry date) |
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11 References |
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Please
give details of referees. One must be your present or last employer and a
second one whom has known you for at least three years. References will not
be taken up before selection. |
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Name
1 |
Name
2 |
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Relationship |
Relationship |
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Organisation |
Organisation |
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Email |
Email |
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Telephone
number |
Telephone
number |
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12 Declaration |
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I
declare that to the best of my knowledge & belief the information I have
given on this form is correct & that the information may be used for
registration purposes under the Data Protection Act 1998 |
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Signed |
Date: |
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