POST APPLIED FOR:

THIS APPLICATION FORM SHOULD BE COMPLETED IN FULL. APPLICATIONS WILL NOT BE CONSIDERED IF THEY ARE SUBMITTED IN THE FORM OF A C.V.

Please note this application form is designed to expand with your answers to the questions.

SECTION 1: Personal Details

Surname: / Forename: / National Insurance Number:
Address:
Post Code: / Telephone Numbers:
Home-
Business-
Extension- / Are you currently employed by WomenCentre?
YES/NO
Do you hold a full current driving licence?
YES/NO
Email:

SECTION 2: Education/Training/Qualifications

Qualifications

Types of education i.e. Secondary School / College / University. / Date from / Date to / Qualifications Gained
(State Level) / Grades / Date

Relevant non-qualification courses attended within the last 5 years

Organising Body / Course Details / Date from / Date to

Membership of Professional Bodies

Body / Membership Status / Date from / Date to

Please note –if you are called for interview please bring your qualifications and membership certificates with you.

SECTION 3: Present or most recent Employer

Name and Address / Nature of Business
Present Salary (incl grade)
Other benefits and emoluments
Telephone Number
Job title / Responsible to
Date of appointment / Notice required
Brief description of duties
Reason for leaving (if no longer employed)

SECTION 4:Previous employment(starting with the most recent)

Please give written information on a separate sheet of paper to explain why you have had gaps in your previous employment.

Employer / Job title / Salary per annum / Date from / Date to

SECTION 5: Details of Relevant Experience and Any Other Information in Support of Your Application

THIS IS WHERE YOU MAKE YOUR CASE FOR THE JOB. Refer to the Job Description and Person Specification, examine the skills and experience being asked for and provide evidence by giving specific examples that you possess those RELEVANT to do the job.
This does not just include paid employment. You could include any experience in voluntary community work or in the domestic sphere. (Additional sheets may be attached where necessary)

SECTION 6: Previous and Current Convictions

Please declare any current or previous convictions including bind-overs and cautions, offences committed as a juvenile, offences committed whilst serving in the armed forces, and committed overseas. ‘Spent’ convictions must be disclosed in applications for posts where Rehabilitation of Offenders Act 1974 (Exemption) Order 1975, as amended by the Rehabilitation of Offenders Act (1974) (Exceptions) (Amendment) Order 1986 require such disclosure.
**Please complete the attached WomenCentre Declaration Form

SECTION 7:Referees (one of whom MUST be your most recent employer)

Referee 1 – a relevant referee from your present or most recent employment.
May we contact this referee prior to interview? Yes/No / Referee 2
Name
Position held
Employer/Company name
Address
Telephone number
Capacity in which known to referee / Name
Position held
Employer/Company name
Address
Telephone number
Capacity in which known to referee
For posts having substantial access to children WomenCentre reserves the right to approach any previous employer

SECTION 8: Health

Statement as to general health. Please give full details of absences from work because of illness and/or other occasions over the last three years. Please give details of any long-term progressive illness.

SECTION 9: Media Analysis

Please state where you learned of this vacancy

In submitting this application (whether signed or not) I declare that I am the person referred to on the form.

I declare that the particulars given above are true to the best of my knowledge

I declare that I am entitled to work in the United Kingdom. I shall produce such original documentation as may be requested to evidence my right to work.

Signature:Date:

Reason for rejection of candidate. Please refer to policy and insert number .e.g 3 withdrawn application.

Confidential

Equal opportunities monitoring form

The centre is committed to being an equal opportunities employer. The aim of our policy is to ensure that all applicants are treated equally irrespective of race, colour, ethnic or national origin or religion, political views or membership, sexuality, age, marital status, disability or trade union membership. To assist in monitoring this policy, and for no other reasons please complete this questionnaire. This information will be kept strictly confidential. It will not be seen or used during the selection process and will be used for statistical monitoring only. To carry out this approach we need your assistance and would be grateful if you would provide the information requested.

N.B. Posts are exempt from the Sex Discrimination Act. Section 7(2) d.

Post applied for:
Surname:
Previous surname (if any):
Forename:
Age:
Date of Birth:
Gender: / Female / Male (delete as necessary)
I describe my sexuality as: / Heterosexual / Gay or Lesbian / Bisexual / Other (delete as necessary)
Do you have a disability? / YES /NO (delete as necessary)
If yes, please state the nature of your disability
ETHNIC ORIGIN
Please indicate your ethnic origin here:
1. White / British
Irish
Any other White background
2. Mixed / White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background
3. Asian or Asian British / Indian
Pakistani
Bangladeshi
Any other Asian background
4. Black or Black British / Caribbean
African
Any other Black background
5. Chinese or other ethnic group / Chinese
Any other

Reasonable adjustments for interviews and tests

Tell us how we can remove any barriers for you in our recruitment process. We want you to do well, so it is important you tell us how we can help. You may need a parking space, a British sign language interpreter, an induction loop or this form in another format. You may just need extra time for your interview due to Dyslexia. Whatever it is you need tell us and we will try to meet your needs.

Note If at any time you feel aggrieved at the manner in which your application is received and/or the way an interview is conducted to which you were invited, you should formally submit, in writing, such a complaint to the CEO of WomenCentre.

WomenCentre Declaration Form

Full Name:

Post applied for:

If you answer yes to any of the questions below, please attach full details including dates, on a separate sheet of paper which you should also sign and date.

1 / Are you currently bound over, or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or any other country? (You do not need to declare parking offences or fixed penalty point fines) / Yes  No 
2 / Have you ever received from the police, a caution, reprimand or final warning? / Yes  No 
3 / Have you been charged with any offence in the United Kingdom, or in any other country that has not yet been disposed of? / Yes  No 
4 / Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you? / Yes  No 
5 / Have you ever been dismissed by reason of misconduct from any employment, office or other position previously held by you? Or are you subject to a currentfinal warning from your current employer? / Yes  No 
6 / Have you ever been disqualified from the practice of a profession, or required to practise subject to specified limitations following fitness to practise proceedings by a regulatory or licensing body in the United Kingdom or any other country? / Yes  No 
7 / Are you currently the subject of any investigation or fitness to practise proceedings, by any licensing or regulatory body in the United Kingdom or any other country? / Yes  No 
8 / Posts subject to Child Protection regulations only:
Are you subject to any other prohibition, limitation or restriction that means weare unable to consider you for the position for which you are applying? / Yes  No 
Not applicable 

DECLARATION

I consent to the information provided in this declaration being used by WomenCentre for the purpose of assessing my application. I confirm that the information I have provided in this declaration form is correct and complete, and that I am required to declare any change to the information provided before I accept any offer of employment/work or subsequent to my accepting an offer of employment/work with WomenCentre.

I understand that if I withhold information or provide false or misleading information this may result in my application being rejected, or if I have started work at WomenCentre terminating my employment by giving me one weeks pay in lieu of notice. (In the case of staff employed by WomenCentrewho have applied for an internal vacancy, concerns will be addressed in accordance with the WomenCentre’s Disciplinary Procedure).

Signed

Date

1