Application Form

It is important you read the job description and person specification before completing the application form. CV and/or other materials will not be assessed.

Application for the post of:
Job Reference:
Name: ………………………………………………………………………………...
Address: ………………………………………………………………………………..
…………………………………………………………………………………
Phone: …………………………………Work: ……………………………………...

May we contact you at work? Yes ÿ No ÿ

Referees (Please give as referees your present and/or most recent employers, most recent place of training or education. We will need two references from referees who are authorised to comment on behalf of the organisation)
Name:……………………………………
Position:…………………………………
Organisation:…………………………..
Address:………………………………..
……………………………………………
Relationship:…………………………..
Phone:…………………………………..
May we contact without further notice reference to you? Yes/No / Name:……………………………………
Position:…………………………………
Organisation:…………………………...
Address:…………………………………
…………………………………………….
Relationship:……………………………
Phone:…………………………………...
May we contact without further reference to you? Yes/No
Employment History: Please outline below your employment details, including relevant voluntary work. Please start with you current or most recent experience. Always give the month and year your employment started and ended (e.g. 01/91-04/98)
From / To / Name of organisation; job title, and brief description of duties / Reason(s) for leaving

(Continue on a separate sheet of A4 paper if necessary)

What is your current salary? £……………………………………………….

How much notice would you have to give your current employer…………………

Relevant Qualifications and Training
From / To / Name of Organisation; course or training / Qualifications earned if any

(Continue on a separate sheet of A4 paper if necessary)

Person Specification: Please address the points outlined on the person specification and provide details corresponding to the essential criteria. Other points will be addresses at interview or in a test. Please be concise and do not exceed the space below.

Evidence of meeting criteria

Disability: If you have a disability, is there anything we need to know in order to offer you fair selection interview, e.g. a signer or tape? Is there any equipment or support you may require to enable you to do this job that BCWA would need to supply for you?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Are you registered disabled? YES/NO

Declaration of interest: Do you have any family of friends who are employed by BCWA, Housed by BCWA or a Member of BCWA Management Committee?

YES/NO

If yes, please state who, and your relationship to them …………………………………………………………………………………………………………………………………………………………………………………….

Do you have a criminal record? YES/NO

If yes, we may want to discuss this following the interview. Please enclose details in a separate sealed envelope addressed to The Manager BCWA, which will not be opened unless we invite you to interview.

Rehabilitation of Offenders Act 1974: This post is subject to rehabilitation of Offenders Act 1974. A criminal record will not necessarily exclude you from this post but under the Act, we must have details.

BCWA aims to promote equality of opportunity for all with the right mix of talent, skills and potential. BCWA welcomes applications from diverse candidates. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Unless the nature of the work demands it, you will not be asked to disclose convictions which are ‘spent’ under the Rehabilitation of Offenders Act 1974. Having an ‘unspent’ conviction will not necessarily bar you from employment. This will depend on the circumstances and background to your offence(s).

I understand that an Enhanced Disclosure will be sought in the event of a successful application for this post and therefore I will be required to give details of spent and unspent convictions (please see declaration at end of application form). BCWA operates under the Criminal Records Bureau Code of Conduct (a copy of which is available on request).

Declaration: I declare that the information given on this form is correct to the best of my knowledge. I understand that if it is discovered that information has been fraudulently or misleading supplied BCWA reserves the right to terminate any contract of employment without notice at any stage.

I confirm that the information I have given on this form is correct and complete, and that any misleading statements may be sufficient for cancelling any agreements made. Because of the sensitive nature of the duties the post-holder will be expected to undertake, I understand that the declaration will include details of any criminal convictions, cautions, reprimands and final warnings, and any other information that may have a bearing on my suitability for the post.

Signature………………………………….. Date………………………………..

(Please note that any information supplied in this form may be stored for reference purposes by BCWA for up to 24 months after the recruitment process has been completed. If you are appointed, this form and any supplementary papers you provide will form a part of your personnel file throughout your employment with BCWA, and be archived for 7 years after the end of your employment).

Thank you for completing this form. Please e-mail to or post to: Recruitment at BCWA, PO Box 71159 London SE20 9BW.

Bromley & Croydon Women’s Aid is a company Limited by Guarantee registered in England No. 3320296 Registered Charity No. 1068007