Bradford BeReavement Support

Registered Charity No: 1137624

Company No. 7321391

Albion Mills

Albion Road

Tel: 01274 619522

E-mail:

Position Applied for:
Name:
Address
(including Postcode):
If you have been at this address for less than two years, please give previous address:
Home telephone no: / Work Telephone no:
Mobile Telephone No: / Email Address:
Employers name and address / Please give exact dates From / to / Job Title & brief description / Salary / Reason for leaving

Education & Qualifications

Please use this section to show how you meet the requirements of the person specification by referring to your education, employment and other relevant experience and by giving examples.

Secondary School College/
University / Dates From / to / Qualifications gained / Grades / Date

Membership of Professional Bodies

Please give previous experience of voluntary work

REFERENCES: Please give the name and address of two referees last employer and not a relative who may be contacted by Bradford Bereavement Support
Referee 1 / Referee 2
Name:
Address:
E-mail:
Tel No: / Name:
Address:
E-mail:
Tel No:
This post will be subject to a DBS check.
Have you ever been dismissed from any paid or voluntary work? Yes / No
Have you ever been convicted of a criminal offence?Yes / No
Are there any matters outstanding which may lead to a criminal prosecution? Yes / No
If you have answered yes to any of the above questions, please give details

Rehabilitation of Offenders Act 1974

Because of the nature of the voluntary work for which you are applying, the post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exemption Order 1976.
Applicants must therefore not withhold information about any court conviction you
have received at any time, regardless of whether the conviction is deemed spent. If you
are successful in becoming a volunteer for BBS any failure to disclose such convictions could result termination of your voluntary work with BBS.
Any information given will be completely confidential and will only be considered in
relation to an application for positions to which the order applies.
DECLARATION: I declare that the above information is true and complete. I understand that any false information may result in termination of my work with BBS.
Signature …………………………………………… Date ……………………………
Bradford Bereavement Support has been registered with the Criminal Records Bureau as an organisation working with vulnerable adults and so staff and volunteers are required to be police checked dependent on their role.
Looking at the Person Specification and Job Description please describe the knowledge, skills and experience you possess for this role?
Additional information:

CONFIDENTIAL

As a workeryou are in a privileged position meeting our clients, Bradford Bereavement Support has a responsibility to ensure that no one becomes a worker would misuse this trust. Therefore, it is essential that you complete and sign this form.

Do you give your permission for this information to be kept on file at Bradford Bereavement Support?

YES/NO

(This information remains confidential and will not be passed on to any third party).

Name:
Do you have any medical condition (physical or mental) that could affect your work as a volunteer? / Yes / No
Have you ever been dismissed from any paid or voluntary work? / Yes / No
Have you ever been convicted of a criminal offence? / Yes / No
Are there any matters outstanding which may lead to a criminal prosecution? / Yes / No
If you answer yes to any of the above questions, please give details:

I give permission for the staff of Bradford Bereavement Support to carry out a police check for criminal convictions, or any other checks with the Department of Health, Social Services or Department for Education. I understand that my National Insurance number may be required.

I know of no reason why I would be unsuitable to work for Bradford Bereavement Support –

Signed: ______Dated: ______

BBS 2018