Application Form (self-employed)

If completing this form by hand, please write in block capitals with black ink. This form must be completed in full even if accompanied by a CV

Surname
(Mr/Mrs/Miss/Ms
Forenames
Preferred first name
National Insurance No.
Address: / Phone: Day
Eve
Mobile
Email
Postcode:

Do you require a work permit to work in the United Kingdom?Yes/No

Post applied for:

EDUCATION: Please give details of your education and qualifications after the age of 11 years.

Schools or College attended / Qualifications and grades obtained
Training Course/Seminar Name / Qualifications gained

EMPLOYMENT HISTORY: Please supply details of your employment record, starting with the most recent. Please account for any gaps. Continue on a separate sheet if necessary.

Date / Employer / Job Description and responsibilities / Reason for leaving

TRANSPORT

Do you hold a current driving licence? / Yes/No
Please indicate the number of penalty points on your licence
Do you have use of a car? / Yes/No
Would you be willing to use this for business purposes? (a mileage allowance is paid). / Yes/No

REFERENCES

Please provide details of two referees, one of whom should be your present/last employer, whom we will approach with regard to your application. Personal referees should not be a relative.

Present/Last Employer

Name
Position in Company
Company address
Daytime telephone no.
Email address
May we approach this person prior to interview?

Personal Referee

Name
Relationship
Address
Daytime telephone no.
Email address
May we approach this person prior to interview?

If you were offered this position, when would you be able to join The Country Trust?

Date:

DECLARATIONS:

The Country Trust is committed to safeguarding and promoting the welfare of Children and Young People and expects all staff and volunteers to share this commitment. Selected post holders are subject to a satisfactory enhanced check with the Disclosure and Barring Service (previous checks were undertaken via the Criminal Records Bureau).

Criminal Conviction

Having a police record does not necessarily mean that you cannot work for The Country Trust. However, the nature of the individuals helped by The Country Trust is such that you are exempt from the requirements of the Rehabilitation of Offenders Act 1974 and you are therefore required to disclose all convictions including spent ones.

Do you have a criminal conviction?Yes/No

If yes supply details:
I confirm that, to the best of my knowledge, all the above information is true and correct. I understand that providing deliberately false information may result in my dismissal or other disciplinary action.
I know of no reason why I should not work with children/young people.
Signature
Date:

If typing your form, please type your name here and if you are invited to interview we will ask you to sign the form.

Please return a copy of your application form (by email) to:

Email:

Thank you for your interest in The Country Trust and your application for this post.

Notes:

Internal Use Only
Date acknowledged
References / Date received:
Other action required:

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