Application Form – MS107

Please complete this form at your earliest convenience. You should complete it electronicallyusing Microsoft Word, and return it to me by e-mail to . If you don’t have Microsoft Word there is a rich text format version of the application form on the Real website.

Before completing this document you should read "Mike Smith’s PA role - information pack". Please think carefully about your answers, and give me enough information so that I think it is worth interviewing you.

Personal details

Title (Mr/Ms/Mrs/Miss etc)
Full Name
Address
Home Telephone
Mobile Telephone
Email
Do you have a UK passport?
If No, please state which country andexplain why you are allowed to work in the UK (see part 21 of the Person Specification)
What is your National Insurance Number?
Do you hold a current Driving Licence valid in the UK, which lets you drive a manual (not automatic) car? (State if UK or international)
Details of any driving convictions or endorsements in the last five years?
Are you 25 or more years old? (It’s a condition of my car insurance that you are)
Do you smoke?
(If Yes, how much/often?)
Have you ever had a DBS (Disclosure Barring Service) check? This was previously known as a CRB (Criminal Records Bureau) check. If yes, state when the last one was done.

Details of current (or if not currently employed, most recent) employment

Name of employer and location
Position
Main duties
Salary
Date started
Date left (if relevant), and reason for leaving
Notice required (if still working there)
Previous employment/roles

Please give brief details of your previous employment history and work experience, either paid or voluntary

Dates

From To /

Employer and location

/ Job title and brief description

Education and training

Please give details of your education and training

Date(s)

/

Education/Training

/

Qualification

Supporting information

Please read the Job Description and the Person Specification and then write a statement saying why you would be good at the job. You should explain how you meet each of the criteria on the person specification. Where possible give examples from any experience (paid or unpaid) that you have that demonstrateseach criteria.
Why are you interested in this position?
What have you done to demonstrate physical strength? (This is to give some evidence that you will be strong enough to let me safely for both me and you. Think about other jobs/roles, sport, etc)

References

Please can you give the names and contact details of two people who are willing to supply references for you. One must be your current or most recent employer and the second referee will, ideally, be another previous employer. Ideally they will have known you for more than 12 months. Do not give a friend asI do not consider them impartial.

Referee 1 / Referee 2
Title (Mr/Mrs/Ms, etc):
Full name:
Job Title:
Address:
Post Code:
Telephone Number:
E-mail address
How long have you know this person?
In what capacity do you know them?
Is it OK to contact them prior to interview?

Working out your preferred working patterns

The purpose of this question is to gain an indication of your likely availability, and is particularly relevant if you have times when you would not be able to work due to other commitments (if these would prevent you from travelling occasionally please indicate why).

Details of any days of the week or times of the day when you would not be able to work on a regular basis due to other commitments

In the information pack, I explain I could recruit one “full-time” or two “part-time” positions. Please write the word "yes" next to the following statement that most applies to you:

I would strongly prefer to work 1 or 2 shifts per week
I would strongly prefer to work 2 or 3 shifts per week
I would be happy working either 1 to 2, or 2 to 3 shifts per week
Dates/times not available for interview (after 10 August)
Earliest date available to start
On which website/source did you find this role?

Criminal convictions

Due to the nature of the position for which you are applying this post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. This means that you are not entitled to withhold information about convictions which for other purposes are `spent' under the provision of this Act, and so must disclose them below. In the event of employment, any failure to disclose such convictions could result in dismissal. A criminal record will not necessarily exclude you from possible employment. Information given will be strictly confidential and will only be taken into account for the purpose of this application.

Details of any criminal convictions (note instructions above)
Declaration
Signature / Date
The answers that I have given are to the best of my knowledge a true statement. I understand that failure to disclose relevant information may lead to instant dismissal if I was to be offered employment.

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