STRICTLY CONFIDENTIAL

Position you are applying for: PA to Executive Director for Samaritan's Purse and BGEA
Where advertised:
Have you applied for a SP vacancy before:

PERSONAL DETAILS

Surname: Forenames: Title:
Address:
Postcode:
Telephone: Work () Home ()
Mobile telephone: Email:
May we contact you at work? YesNo (select as appropriate)

EDUCATION

Secondary school level qualifications. List subjects passed with the grades:
School: From: To:
Address:
SUBJECT / GRADE / SUBJECT / GRADE
Further/Higher Education. List subjects passed with the grades:
School/College/University: From: To:
Address:
SUBJECT / GRADE / SUBJECT / GRADE
Please describe other relevant learning opportunities e.g. training courses, voluntary work
DATE / LEARNING OPPORTUNITY
Vocational Qualifications. Give details of any vocational or professional qualifications you have, and membership of professional bodies, with dates:

PREVIOUS EMPLOYMENT

Please provide information about your current and previous employment. Start with the current or most recent and work backwards. If there is insufficient space, continue on a separate sheet and attach that to this form.
Present/previous employer:
Type of business:
Address: Tel: ()
Starting date:
Leaving date:
Current/Finishing salary: £ Per
Job title:
Duties/responsibilities:
Reason for leaving:
Present/previous employer:
Type of business:
Address: Tel: ()
Starting date:
Leaving date:
Current/Finishing salary: £ Per
Job title:
Duties/responsibilities:
Reason for leaving:

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Present/previous employer:
Type of business:
Address: Tel: ()
Starting date:
Leaving date:
Current/Finishing salary: £ Per
Job title:
Duties/responsibilities:
Reason for leaving:
Present/previous employer:
Type of business:
Address: Tel: ()
Starting date:
Leaving date:
Current/Finishing salary: £ Per
Job title:
Duties/responsibilities:
Reason for leaving:

REASONS FOR APPLYING/WHAT YOU CAN CONTRIBUTE

Describe briefly why you are interested in this position:
Describe your strengths and the particular skills and abilities you would bring to this post.

EXPERIENCE OF USING COMPUTERS

Describe your experience of using computers, specifying in each case whether for work or personal use. List the programmes you have used (e.g. accounts packages, word processor, spreadsheet, database etc.) and your experience of them.

CHRISTIAN LIFE AND EXPERIENCE

Church Affiliation:
Name of Church:
How long have you attended?
Name of Minister/Pastor/Leader?
Would they support your application? YesNo (select as appropriate)
What involvement and responsibilities do you have in the life of the church?

SYMPATHY WITH CHRISTIAN AIMS & OBJECTIVES

Samaritan’s Purse International is a Christian charity providing its services to meeting critical needs of victims of war,
poverty, famine, disease and natural disaster while sharing the Good News of Jesus Christ. Our aim is by these means to further the Christian gospel and advance the Kingdom of God. We expect all of our employees to be in full sympathy with our Christian Ethos and to be able to demonstrate this. Please let us have your own view of this overall aim and explain how you would be in sympathy with it.

GENERAL

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Interests/hobbies:
Positions of responsibility held and public duties undertaken:
Have you ever been convicted by the courts or cautioned by the police for a criminal offence? YesNo
If YES, please give details (declaration subject to the Rehabilitation of Offenders Act 1974).

REFERENCES

Please give details of referees. References may be taken up prior to your first or second interview.
Your Present Employer (or past employer or college tutor/school head if still studying)
Name: Title:
Job Title: Day time telephone: ()
Organisation Name:
Address: Postcode:
May we contact this person before a formal offer has been made? YesNo (select as appropriate)
A Previous Employer
Name: Title:
Job Title: Day time telephone: ()
Organisation Name:
Address: Postcode:
May we contact this person before a formal offer has been made? YesNo (select as appropriate)
Your Minister/Pastor/Leader
Name: Title:
Job Title: Day time telephone: ()
Address: Postcode:
May we contact this person before a formal offer has been made? YesNo (select as appropriate)

OTHER INFORMATION

Are you a National of the European Union? YesNo (select as appropriate)
If you are NOT a National of the EU, do you have the legal right to work in the UK? YesNo (select as appropriate)
National Insurance number:
Please give details of the basis of your eligibility and provide details of any restrictions:
PLEASE NOTE: WE ARE UNABLE TO SECURE WORK PERMITS FOR ANY APPLICANT NOT CURRENTLY ELIGIBLE TO WORK IN THE UNITED KINGDOM. WE ARE ONLY ABLE TO OFFER EMPLOYMENT TO APPLICANTS WHO HAVE THE FULL LEGAL RIGHT TO WORK IN THE UK. EVIDENCE OF ELIGIBILITY WILL NEED TO BE PROVIDED BY ALL SHORT LISTED APPLICANTS.
If offered the position, how much notice would you need before starting?
If there are any other matters you feel are relevant to your application, please use the space below

DECLARATION

As Samaritan’s Purse is, to some extent, a children’s charity, during your employment it may be necessary for you to undergo a Criminal Record Bureau check. This will only take place if an aspect of your role or work brings you into regular or intensive contact with children.
Therefore, should you be offered a contract of employment with Samaritan’s Purse it may become necessary, at any time during your appointment, to give your authorisation for a CRB check to be carried out.
I confirm that the information given on the form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.
Signature /

Date

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This document contains sensitive and personal data which will only be used by SPI for recruitment, selection and statistical

purposes. SPI undertakes to keep this data secure and will make available to you upon request the data that it holds on you.

Please sign that you are in agreement with this.

Signed: Date:

Please return this application form by the closing date to:

Samaritan’s Purse International Ltd

Victoria House

Victoria Road

BUCKHURST HILL

Essex IG9 5EX

Tel: 020 8559 2044

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