APPLICATION FORM

Senior Practitioner (London)

CONFIDENTIAL

Closing Date: 12 noon, 27th November 2017

PERSONAL DETAILS

Surname: / Title:
Forename/s:
Home Address:
Home Telephone: / Work Telephone:
Mobile Telephone:
Email Address:

QUALIFICATIONS: ACADEMIC AND/OR PROFESSIONAL

Institution / Qualifications / From / To

RELEVANT TRAINING

Title / Details / From / To

EMPLOYMENT

List previous employment/experience in chronological order, starting with the most recent. Please include information on experience relevant to this post, which you may have gained outside paid employment. Continue on a separate sheet if necessary.

MOST RECENT EMPLOYMENT

From: / To: / Employer’s Name & Address: / Job Title:
Description of Duties:
From: / To: / Employer’s Name & Address: / Job Title:
Description of Duties:
From: / To: / Employer’s Name & Address: / Job Title:
Description of Duties:
From: / To: / Employer’s Name & Address: / Job Title:
Description of Duties:
From: / To: / Employer’s Name & Address: / Job Title:
Description of Duties:
From: / To: / Employer’s Name & Address: / Job Title:
Description of Duties:

MOST RECENT EMPLOYMENT

Salary: / Notice Period Required: 2

SUPPORTING STATEMENT

Please use this space to give any other information in support of your application. Your application will be short-listed against the criteria in the person specification and role definition. Please type or write clearly and give specific examples to evidence your experience, skills, ability, knowledge and personal abilities. Continue on a separate sheet if necessary.

REFERENCES

Please give the names of two referees (one of whom must be your current or most recent employer) who will be able to provide a description of your suitability for this post.

Name: / Name:
Title: / Title:
Address: / Address:
Telephone Number: / Telephone Number:
May we contact prior to interview? / May we contact prior to interview?

CRIMINAL OFFENCES

If short-listed you will be asked to declare if you have ever been convicted/cautioned of any criminal offences and the successful candidate’s appointment will also be subject to an Enhanced Criminal Records Disclosure prior to confirmation in post.

DECLARATION

I confirm that to the best of my knowledge, the information I have provided in this application is correct.

Signature Date
Please return via email to:
Alternatively please return to (please mark the envelope Private & Confidential):
Lucy Bowyer
Supported Housing Manager
The Albert Kennedy Trust
48 Chocolate Studios
7 Shepherdess Place
London
N1 7LJ

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