Application Form

APPLICATION FOR EMPLOYMENT

Confidential Record

All applicants who meet the requirements advertised will be given fair and equal consideration, regardless of race, sex, colour, creed, nationality, ethnic origin, marital status, sexual orientation, religion, age or disability.

This form must be completed fully and honestly. If not applicable please write "Not Applicable" in the space provided.

APPLICATION DETAILS
POSITION APPLIED FOR
DATE OF APPLICATION

WHERE DID YOU SEE THE POSITION ADVERTISED?

PERSONAL DETAILS
Title / Mr / Ms / Mrs / Miss* /

GENDER

/ Male / Female*

FORENAME

SURNAME

/

NATIONALITY

Home Address

/

Current Address

(If different)

Telephone No.

/

Mobile No.

E-mail Address

* Delete as appropriate

ENTITLEMENT TO WORK IN UK

If you are not an EC citizen does any endorsement on your passport restrict your time or employment in the UK?

Yes  No 

If yes please give details:

EDUCATION & QUALIFICATIONS (starting with most recent)

FROM – TO
(Month/Year) /

INSTITUTION

(Name & Address) / TITLE OF AWARD
(e.g. Degree/PhD. Etc) /
RESULTS
(Achieved/Expected)

Do you speak any other language in addition to English? Please indicate your level of proficiency.

LANGUAGE / SPOKEN / WRITTEN

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BASIC / PROFICIENT / FLUENT / BASIC / PROFICIENT / FLUENT

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Do you have any convictions that are not spent under the Rehabilitation of Offenders

Act 1974?

Yes  No 

If yes please provide details:

EMPLOYMENT EXPERIENCE (starting with most recent)

Company: / Present/final salary:
Address: / Other forms of remuneration/benefits:
Nature of business: / Notice period:
Employment dates: / Most recent position held & nature of duties:
Reasons for leaving: / Previous positions (with dates)
Reference: Name and position (this will not be taken up without your express permission)
Company: / Reasons for leaving:
Address:
Nature of business:
Employment dates:
Reference: Name and position (this will not be taken up without your express permission)
Company: / Reasons for leaving:
Address:
Nature of business:
Employment dates:
Reference: Name and position (this will not be taken up without your express permission)
RELEVANT EMPLOYMENT EXPERIENCES
EXPERIENCE OF TECHNOLOGY
(Use the space below to provide evidence of technology you are familiar with, please include any assistive technologies used by people with a disability )
EXPERIENCE OF DISABILITY
(Use the space below to provide evidence of relevant experience)
EXPERIENCE OF DELIVERING TRAINING AND WORKING WITH PEOPLE
(Use the space below to describe training you have delivered and work you have done supporting or assisting individuals)
PERSONAL INTERESTS & ACHIEVEMENTS
(Use the space below to list any spare time activities)
WHAT ATTRACTS YOU TO WORKING FOR ABILITYNET AND WHY DO YOU WANT TO WORK WITH PEOPLE WITH A DISABILITY?
WHY DO YOU THINK YOU ARE SUITED TO THIS VACANCY?
WHEN WOULD YOU BE AVAILABLE TO START?

DECLARATION

I authorise the Company to obtain references to support this application once an offer has been made and accepted. To the best of my knowledge all the information I have given is true. I understand that any false statement may disqualify me from employment or render me liable to dismissal. I give my consent to my personal information being processed in relation to my application for employment. Data Protection Act - the information given to us in this form will only be used in relation to your application for employment. By signing this declaration you are giving us your express consent to retain and process this information under the Data Protection Act 1998.

SignatureDate

FOR OFFICE USE ONLY
APPLICATION FORM EVALUATED BY:
DATE:
COMMENTS:

Monitoring Form

AbilityNet assures you that any information you provide here will only be used to monitor the effectiveness of our policies and we will take steps to ensure this information remains confidential to a limited number of staff in our HR directorate.

Position applied for:
Date of application:

Monitoring Ethnicity

The following sets out categories for monitoring ethnicity. We ask you to respond to this information request positively as it will help us to ensure that our policies and practices do not inadvertently discriminate against you because of your ethnicity.

How would you describe yourself?
Choose ONE section from A to E, and then tick the appropriate box
A Asian or Asian British
 Bangladeshi
 Indian
 Pakistani
 Any other Asian background, please write here:
B Black or Black British
 African
 Caribbean
 Pakistani
 Any other Black background, please write here:
C Chinese or other ethnic
 Chinese
 Any other, please write here:
D Mixed Heritage
 White and Asian
 White and Black African
 White and Black Caribbean
 Any other Mixed background, please write here:
E White
 British
 English
 Irish
 Scottish
 Welsh
 Any other white background, please write here:
F  Prefer not to say

Disability monitoring

To make positive changes, AbilityNet wants to address the different barriers faced by disabled people. Many people who do not consider themselves to be disabled may be covered by the Equality Act 2010 because they have a health condition that impacts on their lives.

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Monitoring Form – page 2

Do you consider yourself to have a disability or long-term health condition? YES / NO
What is the effect or impact of your disability or health condition?
 Prefer not to say

Gender monitoring

Gender monitoring is key to ensuring that all employees have access to the same opportunities and AbilityNet is committed to work to achieve this.

Would you describe yourself as :
 Male? Female? Prefer not to say

Religion and belief

Abilitynet is committed to ensuring fairness and equal access to all employees whatever their faith or beliefs.

Below is a list of religions that are most commonly found in Britain. They are listed in alphabetical order. We acknowledge that the list is not exhaustive and if your religion is not specifically listed we ask you not to take offence as none was intended.

Please tick the box that best describes you:
 Buddhist
 Christian
 Hindu
 Jew
 Muslim
 Sikh
 Other Religion or Belief (please state):
 No Religion
 Prefer not to say

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