Application for Employment

Please complete this form in block capitals with black ink or typescript. The downloaded version can be completed on a computer. All information will be treated in confidence.

Return the form by post to: Human Resources Department, Age UK Essex, Widford Hall, Widford Hall Lane, off Tattersall Way, Chelmsford, Essex CM2 8TD or by email to

Position applied for:
Please state how this vacancy came to your notice. If an advertisement, please state which publication.

Personal Details

Surname
First Name
Home address
Postcode
E-mail address
Home telephone no.
Work telephone number
Mobile number
National Insurance number

Personal Details

Do you have the right to work in the UK without restrictions? / Yes* / No*
If the answer is no please give details.
Do you hold a full valid driving licence? / Yes* / No*
Do you own a car and have daily access to it? / Yes* / No*

*(Please delete as appropriate)

Present or Most Recent Employment

Employer’s Name and Address
Job Title
Date appointed
Current grade / salary
Notice required / date of leaving
Brief outline of duties
Reason(s) for leaving

Previous Employment

(Please continue on a separate sheet if necessary)

Employer’s Name and Address
Job Title
Date appointed
Grade / salary
Date of leaving
Brief outline of duties
Reason(s) for leaving
Employer’s Name and Address
Job Title
Date appointed
Grade / salary
Date of leaving
Brief outline of duties
Reason(s) for leaving

Previous Employment Cont’d

(Please continue on a separate sheet if necessary)

Employer’s Name and Address
Job Title
Date appointed
Grade / salary
Date of leaving
Brief outline of duties
Reason(s) for leaving
Employer’s Name and Address
Job Title
Date appointed
Grade / salary
Date of leaving
Brief outline of duties
Reason(s) for leaving

Education and Training

(Please continue on a separate sheet if necessary)

School(s) & College(s) / Qualifications Obtained / Grade / Date

References

Please give details of at least two people whom we may approach for references. These should be from your current employer, and all other employers you have had during the past two years*. If you are not in employment, your referees should be your most recent employer and/or tutors or other senior persons from your school, college or university. If any of your referees knew you by a different name, please give details.

*Note: If necessary, please use a separate sheet to provide details of these referees.

1. Name
Job title
Address
Telephone
E-mail address / fax number
May we contact this person before interview?
*Delete as appropriate / Yes* / No*
2. Name
Job title
Address
Telephone
E-mail address / fax number
May we contact this person before interview?
*Delete as appropriate / Yes* / No*

Relationships

To your knowledge, are you related to any of our employee(s) or member(s) of the Board of Directors / Trustees? (*Delete as appropriate)

Yes* No*

If yes, please give details:

Experience and Abilities

Using the Job Description and Person Specification please match your own experiences and abilities to those outlined below.

Please feel free to expand the reply boxes or use a separate sheet if you wish to give us further information.

Knowledge & Experience
Skills & Abilities
Qualities & Attributes
Working Knowledge of Voluntary Sector

Additional Information in Support of your Application

This is your opportunity to tell us how your experience and abilities make you a suitable candidate for this post. Please refer to the job description and the person specification, taking into account the essential and desirable criteria, and use this space to provide any other information you wish us to consider, which has not already been provided elsewhere. This could include relevant experience and abilities gained during gaps in paid employment, for instance, through voluntary work and/or community activities.

You may continue on a separate sheet if necessary.

Concerns

Please let us know of any concerns that may affect your ability to carry out the tasks listed in the job description and person specification.

Interests

Please give details of any interests you have and activities you enjoy.

Disability

It is our standard practice to ask all short-listed candidates whether there are any special access requirements we need to take into account during the next stage of the recruitment process. If you need to receive or submit any recruitment information in alternative format (e.g., large print, or on disk/CD), please give details below.

Declaration

I certify that, to the best of my belief, the information I have provided is true, and I understand that any false information may, in the event of employment, result in dismissal or disciplinary action.

Signed Date

Application for Employment

Equal Opportunities Monitoring Form

In order to help us monitor the implementation of our equality and diversity policies and action plans, please complete this form and return it with your application form. This form will be kept separate from your job application, and your responses will not be made known to any member of the selection panel. Your details will be entered and stored securely on the Human Resources Information System, after which this paper form will be destroyed.

The information you provide will be treated as confidential and will be used for Equal Opportunities monitoring, and for compiling statistical returns. Reports using this information will be in anonymised format to prevent identification of any individual.

Please tick the boxes or fill in information as appropriate.

Title

/ First Name / Surname
Position applied for
Gender / ¨ Male ¨ Female
Date of birth (dd/mm/yyyy)
Nationality
Marital status / ¨ Married / civil partnered ¨ Single
¨ Divorced ¨ Legally separated
¨ Widowed

Religion or belief

/ ¨ Buddhist
¨ Hindu
¨ Muslim
¨ Some other religion or belief / ¨ Christian
¨ Jewish
¨ Sikh
¨ No religious belief
Ethnic origin
(Census 2011 Ethnicity Categories) / A White
¨ English/Welsh/Scottish/Northern Irish/British
¨ Irish
¨ Gypsy or Irish Traveller
¨ Other White Background (write in)
B Mixed/multiple ethnic groups
¨ White and Black Caribbean
¨ White and Black African
¨ White and Asian
¨ Any other mixed/multiple ethnic background (write in)
C Asian/Asian British
¨ Indian
¨ Pakistani
¨ Bangladeshi
¨ Chinese
¨ Any other Asian background (write in)
D Black/African/Caribbean/Black British
¨ African
¨ Pakistani
¨ Caribbean
¨ Any other Black/African/Caribbean background (write in)
E Other ethnic group
¨ Arab
¨ Any other Black/African/Caribbean background (write in)

Sexual orientation

/ ¨ Heterosexual
¨ Gay / lesbian
¨ Bisexual
¨ Other

Disability

/ ¨ No known disability
¨ Specific learning disability (such as dyslexia or dyspraxia)
¨ General learning disability (such as Down's syndrome)
¨ Cognitive impairment (such as autistic spectrum disorder or
resulting from head injury)
¨ Long-standing illness or health condition (such as cancer, HIV,
diabetes, chronic heart disease, or epilepsy)
¨ Mental health condition (such as depression or schizophrenia)
¨ Physical impairment or mobility issues (such as difficulty using
arms or using a wheelchair or crutches)
¨ Deaf or serious hearing impairment
¨ Blind or serious visual impairment
¨ Other type of disability

Thank you for taking the time to complete this form.

Rehabilitation of Offenders Act 1974

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)

YES / NO

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘Protected’ and are not subject to disclosure to employers, and cannot be taken into account.

Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

If you answer “no”, please sign and date declaration A below and return this form with your application.

If you answer “yes”, please complete, sign and date declaration B below and return this form with your application, accompanied by a sealed envelope containing details of the convictions or cautions and showing the date of each offence, the nature of each offence and the outcome. You should write your name and the position you are applying for on the outside of the sealed envelope. If you are not selected for this post, the details will be returned to you.

You should note that providing false information to obtain employment is a criminal offence

A I declare that I have no criminal convictions, cautions or bind-over orders to disclose

Name:………………………………………………………………………..

Signed:………………………………………………Date:…………………

B I declare that I do have criminal convictions, cautions or bind-over orders to disclose, and that I have included details of these with my application

Name:………………………………………………………………………..

Signed:………………………………………………Date:…………………

For office use only

Ref:

For office use only

Ref:

For office use only

Generic Application Form / Introduced: May 2014
Page 1 of 10 / Reviewed: March 2016
Version 4 / Next review: March 2017