Application for post of CHESS Senior Winter project worker

Please complete this form in type or block capitals and send or deliver it to:

Barbara Buxton, Chelmsford CHESS 200 New London Road, Chelmsford, Essex CM2 9AB

To arrive by close of business on, or before 24th October 2017. We would like to receive the original copy if possible but due to the short deadline e-mail will be accepted

Shortlisted applicants will be contacted in due course and will be interviewed in Chelmsford during the month of November (date is to be arranged)

If there is insufficient space in any section, please use a separate sheet. We will not divulge the information you give on this form to any third party unless required to do so by law.

Applicant’s details

Surname:
Any previous surnames:
(including any maiden name)
Forenames:
Date of birth:
Address:
(including post code)
Daytime telephone number:
Evening telephone number:
Mobile telephone number:
Email address:

Employment

Please give details of your employment history since leaving full-time education.
Use a continuation sheet if necessary.
Current employment
Employer’s name and address: / Nature of employer’s business or operation:
Date started:
Salary: / £
Job title:
Your role:
Reason for wanting to leave:
How much notice do you have to give?
Previous jobs
(most recent first)
Employer’s name and address: / Nature of employer’s business or operation:
Date started:
Date left:
Job title:
Your role:
Reason for leaving:
Employer’s name and address: / Nature of employer’s business or operation:
Date started:
Date left:
Job title:
Your role:
Reason for leaving:
Employer’s name and address: / Nature of employer’s business or operation:
Date started:
Date left:
Job title:
Your role:
Reason for leaving:

Voluntary Work

Please give details of any unpaid voluntary work you are doing now, or have done in the past, in the public or charitable sectors. What sort of work it is / was? How often do / did you do it each month?

Education

Degrees and relevant professional qualifications
(We may ask for evidence of degrees and qualifications gained)
Degree or qualification / Awarding institution / Year awarded
Other training
Please give details of any other courses or training you have undertaken that you consider relevant to this
application

Additional information about you

Do you have a current full UK driving licence? / Yes / No
Is your license clean? If no give details of convictions
In the past 5 years
Hobbies and interests
Please tell us about them even if you don’t think they are relevant
Experience
Please tell us about any relevant experience you within this sectorthat is not mentioned elsewhere
Medical history
Have you been ill or absent from work for a period of more than a week during the
last five years? / Yes / No
If so, please give details
Criminal convictions
Do you have any unspent criminal convictions? / Yes / No
If so, please give details. A criminal conviction is not necessarily a bar to appointment but, because many
Homeless people are vulnerable, appointment will be subject to a DBS check.
We will not employ any person who fails to give details of any unspent convictions.

You and the post of Senior Winter project worker

How did you learn about it?
What interests you about this post?
What qualities do you think you will bring to the role at this stage in CHESS’ development?
What would you like to achieve for CHESS?
What would you like to achieve for homeless people?
What would you like to achieve for yourself?

Personal comments

Is there anything you would like to add or are there any comments you wish to make?

References

Please give the names, addresses and telephone numbers of two individuals, other than your current employer and who are not related to you, for us to contact for references. Your first-named referee should be someone who can tell us about you in relation to your work or profession. Your second-named referee may be anyone you consider appropriate. We will not contact your referees unless you are shortlisted for interview.
First referee
Name:
Address (including post code):
Daytime telephone number:
Email address:
Position or profession:
Capacity in which known:
How long known?
Second referee
Name:
Address (including post code):
Daytime telephone number:
Email address:
Position or profession:
Capacity in which known:
How long known?

Application

I apply for the post of Winter project senior worker for Chelmsford CHESS. To the best of my knowledge and belief the information given in this application is correct.
Signed: / Date:

Permission to contact referees

I confirm that, should I be shortlisted for interview, Chelmsford CHESS has my permission to:
  • contact the two referees named above
  • contact my current employer *

Signed: / Date:
* Delete this line if you would prefer us not to contact your employer until after you have been interviewed