Baca.2016

CONFIDENTIAL

APPLICATION FORM – Waking Night Worker

Please return completed form, together with a copy of your CV.

The information you provide in this application form will not be available to anyone other than members of the Baca management team and staff who will be involved in the interview process.

Contact Details

Name of Applicant:

Address:

Postcode:

Tel No: E-Mail:

Qualifications/Education

Please detail the educational instates you have attended and qualifications achieved (expand the box as required):

Name of School/ College/University / Dates Attended / Qualifications Achieved / Dates Obtained

Employment History

Please list all current and previous employment (expand the box as required):

Employer Name / Job Title / Start Date / Leaving Date

Further Training

Please list off additional training you have attended and/or qualifications attained (expand the box as required):

Training / Provider / Date Completed / Certificate (Y/N)?

If there are any gaps in your time in Education & Employment, please explain below:

Role Specific

Having read the Job Description paper, please answer the following questions. You may expand the boxes or use additional sheets as required to answer the following questions:

What interests you about this role?

What skills and strengths will you bring to this role?

What relevant experience/qualifications do you have? E.g. work with young people/different cultures, work within housing provision, management experience

Origination Vision & Values

How do Baca’s Vision and Values fit into your own personal vision and values?

What is the earliest time that you could be available to commence with Baca?

Personal

1.  Please complete the following table.

Strengths / Weaknesses
1. / 1.
2. / 2.
3. / 3.

How would you describe your approach to work/life balance?

Where do you see yourself in 2, 5 and 10 years’ time?

Please comment below if there is anything else you think the interview panel should know that might have a bearing on the applicant’s suitability for the role for which they are applying.

Please give details of two people we can use as referees (please note we will not contact these individuals until after an offer has been made).

Name: Name:

Address: Address:

Email: Email:

How do you know this person? How do you know this person?

Declaration

Please be aware that the provision of false information may result in your application not being considered or the termination of your employment.

I certify that the information in this application is accurate and complete to the best of my knowledge. I understand that the Charity may decline my application without giving reason.

Signed: Date:

Please return this application form together with a CV to the Baca office for the attention of Shahab Ejlali.

Please either email the form to

Alternatively post to the Baca main office at

46 Derby Road Loughborough LE11 5B.

The envelope should be marked ‘Confidential: To be opened by addressee only’.

EQUAL OPPORTUNITIES MONITORING

Baca is committed to ensuring equality of opportunity in its recruitment and employment practices. To help us identify possible inequalities and barriers to employment, we would appreciate your cooperation by completing this form.

The information provided will not influence any part of the selection process and will not be shared with the interview panel. All information you disclose will be treated confidentially and will only be used for statistical and monitoring purposes. Should you choose not to provide details for the following questions, the success of your application will not be affected.

Baca has a diverse team and we are committed to ensuring that our staff reflect the communities we serve.

Please answer the following questions by ticking the appropriate box or writing in the space provided.

1.  Post you are applying for:
2.  Are you Male or Female? / Male Female
3.  Are you a refugee, a former refugee or asylum-seeker? / Yes No
4.  What is your country of origin?
5.  How would you describe your ethnic origin?
Asian:
Asian British ❏
Indian ❏
Pakistani ❏
Bangladeshi ❏
S. East Asian ❏
Any other Asian
(please specify)
/ Black:
Black British ❏
Caribbean ❏
African ❏
Any other Black background (please specify)
/ White:
White British ❏
Irish ❏
Any other White background
(please specify)
Mixed:
White & Black Caribbean ❏
White & Black African ❏
White & Asian ❏
Any other mixed background (please specify)
/ Chinese or other ethnic group:
Chinese ❏
Any other (please specify)
/

Middle Eastern:

Middle Eastern ❏
Any other (please specify)
6.  Do you consider yourself to have a disability? / Yes No
7.  How did you find out about the job?
Are you already a Baca employee / Yes No
Are you a volunteer at Baca / Yes No

Thank you for taking the time to complete this form.

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BFHR18/v2 46 Derby Road, Loughborough. LE11 5BX Tel. 01509 550438