/ Application for Employment
Strictly Confidential
Your application will not be considered unless this form is filled in completely. CV’s can be attached as supplementary information only.
·  Please complete your form using black ink
·  At plus dane group, we recruit for attitude. In order for us to get the right impression of you, please complete the answers to the questions of this form as fully as possible
·  We are keen to hear about any voluntary / community work and other experience you may have had as well as paid work you have undertaken / The Housing Association Act
Are you related to a plus dane group Board / Committee member or any member of plus dane group staff?
Are you a tenant of plus dane group? / Yes No
Yes No
Please give details of the post you are applying for
Personal Details
Surname / Title / Please provide details and state if you can be contacted on the following:
Forenames / Home Telephone / Yes No
Address / Work Telephone / Yes No
Mobile Number / Yes No
E-mail Address / Yes No
Do you own a car? / Yes No
Do you have a full driving licence? / Yes No
Post Code / N.I Number
Education / Training / Membership of Professional Bodies
Qualifications gained or being studied for, training courses attended / Level / Year
Employment History
Please give details of your previous employment. Start with your most recent first. You should include paid work, voluntary work or work at home. Please continue on a separate sheet if necessary.
Your current or most recent employer
Job Title / Type of business
Name and Address of employer
Start date / Leaving date (if applicable)
Reason for leaving or wanting to leave
Current or last salary / Period of notice
Duties and responsibilities
Previous Employment
Company name and position held / Start/leaving date / Reason for leaving / Duties and responsibilities
Please give an answer to the competency based questions below
Serving customer and neighbourhoods
Describe an occasion when you have delivered excellent customer service
Learning and innovation
Give an example of when you have developed an idea which has led to positive outcomes
Working in partnerships
How have you worked successfully in partnerships?
Operational excellence
Give an example of when you have overcome a problem or barrier to achieve success
Seeing the bigger picture
How do you see the post you are applying for contributing to the success of the organisation?
Communicating and influencing
Give an example of when you have used effective communication skills
Confidence, resilience and integrity
Give an example of when you have respected the differences and diversity of others
Please give details of how you meet the technical skills outlined in the competencies for this post
Asylum and Immigration Act 1996
Under the act we have a duty to check that anyone employed has the appropriate permission to live and work in the UK. Will you be able to provide evidence that you are eligible to work in the UK e.g. National Insurance details, passport. / Yes No
If No, please give details
The Rehabilitation of Offenders Act 1974
Please give details of current criminal convictions. You may be required to provide further details of spent convictions for some posts as certain provisions of the Rehabilitation of Offenders Act 1974 do not apply to them. If none please enter ‘none’. Some posts will require a check with the Criminal Records Bureau, if you have any queries about this please contact the HR Team.
Public Duties
Please give details of any Public Duties you currently undertake (e.g. School Governor / Magistrate)
Data Protection
In accordance with the Data Protection Act 1998 plus dane group retains employment information for 6 months on receipt of an unsuccessful job application form or following an unsuccessful interview. Records are also held during employment and after employees leave.
Under the act you will be unable to have access to any reference which your referee has requested should be treated as confidential.
References
plus dane group requires references from two referees who are not related to you. One reference must be from your current employer (or most recent employer) and the other from a previous employer. If you are a school leaver / graduate your first referee must be your Headteacher / Tutor.
First Referee / Second Referee
Name / Name
Position / Position
Address / Address
Postcode / Postcode
Relationship e.g. line manager / Relationship e.g. line manager
Telephone / Telephone
Email / Email
I do not wish references to be taken without my specific permission. (Tick box) / I do not wish references to be taken without my specific permission. (Tick box)
Declaration
I confirm that to the best of my knowledge the information contained in this form is true and correct. I understand that if it is subsequently discovered that any statement is false or misleading plus dane group has the right to dismiss me from my employment. I also understand that canvassing will disqualify, and any offer of the post may be subject to a satisfactory medical examination and written references. I declare that I am eligible to live in the United Kingdom.
Signature of applicant / Date
If you return this form by email without signature you will be assumed to have accepted the above declaration.
With certain exemption, plus dane group cannot offer employment to anyone who is currently a Board / Committee member of plus dane group or who has been a Board / Committee member in the past 12 months. There may be constraints regarding offers of employment to plus dane group tenants.
Please return your completed application form and any additional information to:
HR Team
plus dane group
13-15 Rodney Street
Liverpool
L1 9EF
Alternatively you can email this form to
Any queries please contact HR Team on 0151 708 0674.
/ Equal Opportunities Monitoring
Strictly Confidential
Name: / Date of Birth: / Age:
Position applied for:
Where did you see this post advertised?
Please tick the box next to the words which best describe you.
White / Mixed / Gender / Sexual Orientation
British / White & Black Caribbean / Male / Female / Heterosexual / Straight
Irish / White & Black African / Is your gender identity the same as the gender you were assigned at birth? / Lesbian / Gay Woman
Other / White & Asian / Yes / No / Gay man
Other / Prefer not to say / Bisexual
Black/Black British / Asian/Asian British / Prefer not to say
Caribbean / Indian
African / Pakistani
Other / Bangladeshi
Other
Chinese / Other
Prefer not to say / Religion or belief *
*Please complete if you wish
If you are disabled, we want to support you in your application, at interview and in your employment if you join us. We will provide any reasonable adjustment, for example, equipment, adjustment to working arrangements and duties.
The Disability Discrimination Act 1995 describes disability as a “Physical or mental impairment which has
a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.”
A long term effect is one which has:
(a)  lasted at least 12 months
(b)  is likely to last for a period of at least 12 months, or
(c)  is likely to last for the rest of the life of the person affected.
Given this definition would you describe yourself as having a disability? / Yes No Prefer not to say
If yes, please tell us the nature of your disability?
If YES, please give details and any adjustments to the workplace you may require. plus dane group will make reasonable adjustments to assist you.