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DUSTON PARISH COUNCIL

Duston Community Centre
Pendle Road
Duston
NN5 6DT
Tel: 01604 583626
email:

Please complete all sections clearly in black ink
POST APPLIED FOR:
SURNAME: / FORENAMES:
ADDRESS: ……………………………….……..
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POSTCODE: ……………………….…..………
EMAIL ADDRESS: ……………………………
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Home: ………………………………………..
Work:: ………………………………………..
DO YOU OWN A CAR? YES / NO
DO YOU HOLD A FULL DRIVING LICENCE? YES / NO
NATIONAL INSURANCE NO:
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PRESENT/LAST JOB TITLE: ……………..
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DATE LEFT: (if applicable): ……………………..
NAME AND ADDRESS OF EMPLOYER:
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REASON FOR LEAVING:
SALARY: …………………………………….
BRIEF DESCRIPTION OF YOUR CURRENT RESPONSIBILITIES/DUTIES:
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EDUCATION (Secondary onwards)
Schools and Colleges / FROM: / TO: / EXAMINATIONS PASSED & GRADES:
TRAINING COURSES ATTENDED WITH DATES:
EMPLOYMENT HISTORY - MOST RECENT FIRST (PLEASE GIVE MONTH & YEAR):
(Please explain any gaps in employment)
EMPLOYER / JOB TITLE / FROM / TO / BRIEF OUTLINE OF DUTIES & REASON FOR LEAVING
Please give details of RELEVANT EXPERIENCE AND SKILLS and any FURTHER INFORMATION which you consider makes you a suitable applicant for this appointment:
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OTHER INTERESTS (List briefly your other interests, including any voluntary work, achievements and skills):
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EMPLOYER REFERENCES:
Please give the names of two referees below, preferably your current and last employers. If you are (or have recently been) a student, one referee should normally be the Head or a senior staff member of your place of study:
NAME:………………………………
ADDRESS: ……………………………………
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TELEPHONE NO: ……………………………
POSITION/STATUS: ………………………… / NAME: ……………………………………
ADDRESS: ………………………………………
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TELEPHONE NO: ………………………………
POSITION/STATUS: ……………………………
May these referees be contacted if you are shortlisted? 1. Yes / No 2. Yes / No
ARE YOU, TO YOUR KNOWLEDGE, RELATED TO ANY MEMBER OF STAFF OR COUNCILLOR? IF YES, PLEASE GIVE DETAILS:
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DECLARATION:
I confirm that to the best of my knowledge the information given on this form is correct.
Signed ………………………………………………. Date ……………………………………….
Please return this form to:
Duston Parish Council
Duston Community Centre
Duston
Northampton
NN5 6DT
Or SCAN AND RETURN BY EMAIL TO:

Telephone Number: / 01604 583626
Where did you see this position advertised? ……………………………….………………………………