Application form

Section A: Please note that if you have a disability and require this form in a different format, such as large print, please contact us by writing, emailing or telephoning.

Section A and D of the application form will be detached prior to short-listing. Panel members will not have details of your personal information until after shortlisting has been completed.

Post applied for:
Location
How did you hear about this vacancy?

Personal details

Family name (including preferred title)
First names
Address (including postcode)
Contact telephone number
Email address
Nationality
National insurance number
Are you eligible to work in the UK? / YES: NO:
Please state what documentation you can provide to demonstrate this,e.g. British passport, EEA, ID card, or travel document showing authorisation
Date of birth (optional)
Previous surname(s) used (if applicable)

Criminal convictions

Have you ever been charged with, cautioned or convicted of a criminal offence? / YES NO
Are you currently under investigation, awaiting trial, verdict or sentencing in any criminal proceedings? / YES NO

If yes, please attach details including the offence and the date

Section B: Employment details

Name and address of current employer
Telephone number
Date of appointment to organisation
Job title
Contract type
(Temporary / Permanent)
Type of appointment
(Full-time / Part-time)
Salary / allowance details
Reasons for leaving / seeking new employment
Date free to take up appointment (DD/MM/YY)

Previous employment

Please list your most recent positions first and continue on a separate sheet if necessary

Name and address of employer / Position held
(Please state if full-time or part-time) / Start date
(mm/yy) / End date
(mm/yy) / Reason for leaving

Referees

Please give the name and address of two people whom we can contact for a reference. One of these needs to be from your current or most recent place of employment. We will not contact these referees without your prior consent.
First referee / Second referee
Name
Position
Organisation
Relationship to you
Address
Telephone
Email
Is this referee aware of your application?
YES NO
Are you willing for this referee to be approached prior to interview?
YES NO / Is this referee aware of your application?
YES NO
Are you willing for this referee to be approached prior to interview?
YES NO

Section C: Please complete the following sections using additional space if necessary

How do you see your personal qualities and professional experience qualify you for this post? (Please refer to the job description and person specification)
What values do you think are most important to the work of the charity?
Details of your personal interest in the position
Training/course(s) (relevant to this application and taken within the last five years)
Course / Date / Qualification/details
Professional qualification(s) (including membership to any professional bodies)

Section D: Equal Opportunities

AF Association seeks to ensure equality of opportunity for all who apply for employment with the organisation. We are actively opposed to discrimination and want to ensure our processes support recruitment of the full diversity of people. We believe monitoring our recruitment results will help us assess any areas requiring improvement. In order to assist us with this, we would be grateful if you would complete the form and enclose it with your application.
AF Association undertakes that this form will not be made available to anyone involved in the recruitment and selection of staff for this post and will remain confidential to AF Association used solely for the purpose of monitoring our equal opportunities procedures.
Your help in this matter is entirely voluntary and will in no way affect your application
Please indicate your gender Male Female
Please indicate your age
16-17 18-21 22-30
31-40 41-50 51-60
61-75 66-70 71+
Ethnic origin
White
English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy or Irish traveller
Any other white background
Please state ______
Mixed/multi ethnic groups
White and black Caribbean
White and black African
White and Asian
Any other mixed or multi ethnic background
Please state ______
Asian / Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Please state ______
Black / African / Caribbean / Black British
African
Caribbean
Any other Black/African/Caribbean background
Please state ______
Other ethnic groups
Arab
Any other ethnic groups
Please state ______
Do you consider yourself to have a disability within the meaning of the Equality Act 2010?
YES NO
If you have selected yes, please select the nature of this:
Physical/sensory impairment
Learning difficulty and specific learning difficulties
Mental health difficulties
Medical conditions
Disability definition
The Equality Act 2010 states: ‘A person has a disability if they have a physical or mental impairment, which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.’
The Act goes on to say, ‘A person can also have a disability is s/he had a disability in the past and/or if s/he was on the register of disabled persons under provision in the Disabled Persons (Employment) Act 1944 on both 12 January 1995 and 2 December 1996.’

Please return your completed application form to:

Email:

Post: AF Association, PO Box 6219, Shipston-on-Stour, CV37 1NL

If returning this application form electronically, you are confirming that the information is true and accurate to the best of your knowledge. If you are short listed for this post, we will require your signature prior to interview

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