Carers Network Westminster

Application Form - Caseworker

PERSONAL INFORMATION

Surname: / First Name(s):
Address :
Postcode:
Daytime Telephone Number:
Email address:

Are there restrictions on your ability to work in the UK (please tick)? Yes No

(If yes, please give details below)

REFERENCES

Please give details of two people (not relatives) who would be willing to provide references for you. Please note that one referee must be your present or most recent employer. Written references will be taken up after the offer of a position.

Name: / Name:
Job title: / Job title:
Address: / Address:
Telephone: / Telephone:
Email address: / Email address:
In what capacity do you know this person? / In what capacity do you know this person?

EDUCATION, TRAINING AND QUALIFICATIONS

Secondary School

Name: / Address:
Date from (mm/yy): / Date to (mm/yy):
Examination/Subject: / Result/Grade:
Examination/Subject: / Result/Grade:
Examination/Subject: / Result/Grade:
Examination/Subject: / Result/Grade:
Examination/Subject: / Result/Grade:
Examination/Subject: / Result/Grade:

College/University

Name: / Address:
Date from (mm/yy): / Date to (mm/yy):
Course/Subject: / Result/Grade:
Course/Subject: / Result/Grade:
Course/Subject: / Result/Grade:

Other relevant training or professional qualifications

Course title: / Date obtained (mm/yy):
Course title: / Date obtained (mm/yy):
Course title: / Date obtained (mm/yy):
Course title: / Date obtained (mm/yy):

CURRENT OR MOST RECENT EMPLOYMENT

Name of current or most recent employer:
Full address:
Job title: / Salary:
Date employment commenced:
Date employment ended or, if still employed, notice period:
Reason for leaving/seeking to leave:

Describe the work you do/did:

Please detail your key achievements in this post:

EMPLOYMENT HISTORY

List below your past employment, beginning with your most recent, use a separate sheet if necessary. Please make sure to include and account for any gaps.

Name of employer:
Full address:
Employed from: / To: / Reason for leaving:
Job title:

Describe the work you did:

Name of employer:
Full address:
Employed from: / To: / Reason for leaving:
Job title:

Describe the work you did:

Name of employer:
Full address:
Employed from: / To: / Reason for leaving:
Job title:

Describe the work you did:

Name of employer:
Full address:
Employed from: / To: / Reason for leaving:
Job title:

Describe the work you did:

VOLUNTARY EXPERIENCE

Please describe below any voluntary work you have participated in which is relevant to your application, using a separate sheet if necessary:

PERSONAL STATEMENT

Please review the job description and outline how your skills and experience meet the criteria in the person specification below. You may use a separate sheet if necessary. Applications will not usually be considered unless this section of the form is completed.

DECLARATION

The information above and in the rest of this application is to the best of my knowledge true and complete.

Signed: Date Date:

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