…continued

Please complete in black ink.

Position applied for:
Where did you see the position advertised?
PERSONAL DETAILS
Surname: First name(s):
Home telephone: Mobile telephone:
Home Address:
Post Code:
Email Address:
National Insurance Number:
Age if under 18:
Are you eligible to work in the UK? Yes/No Do you require a work permit to work in this country? Yes/No
If Yes, please give details:
REHABILITATION OF OFFENDERS ACT
Have you ever been convicted of a criminal offence? Yes/No
Have you any prosecutions pending? Yes/No
If yes, please give details/dates of offence(s) and sentence:

Are you registered disabled? Yes/No
Do you need any special assistance/reasonable adjustments, due to disability or a health condition, to enable you to attend an interview? If so, please give details.
FOR OFFICE USE ONLY: Equal opportunities monitoring No:
FOR OFFICE USE ONLY: Equal opportunities monitoring No:
PRESENT OR LAST EMPLOYER
Please provide name, address and telephone number and indicate the type of business
Position held
Dates employed
Brief description of duties and responsibilities
Reason for leaving
Notice required
Referee’s name and position
Please advise if we can approach referee prior to interview: Yes/No
EMPLOYMENT HISTORY
(please list chronologically and explain any gaps)
Name and Address of Employer / Date
From: / Date
To: / Job Title/Job Function/Responsibilities: / Reason for leaving
EDUCATION/TECHNICAL AND PROFESSIONAL QUALIFICATIONS & PERSONAL DEVELOPMENT
(please include any courses, memberships, voluntary work or responsibilities you consider relevant)
Date
From / Date
To / Name of School/college or University / Examinations taken and Qualifications gained (i.e. Specify Grades)
PERSONAL ATTRIBUTES
Please state why you have applied for this post. Indicate past achievements, experience and personal qualities relevant to your application. What contribution would you expect to make in the post?
Please continue on a separate sheet if you wish.
REFERENCES
Please give the name and address of two referees.
One should be a recent employer and one should be a personal reference.
References will only be applied for once your permission has been sought.
Employer Reference
Referee name:Company name:
Job title:Address:
Telephone number:Email address:
Personal Reference
Referee name:Address:
Telephone number:Email address:

Rehabilitation of Offenders Act 1974

Depending on the work for which you are applying, this post may be exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act, and, in the event of gaining employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Company.

Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies. The Anvil Trust will require successful applicants to authorise a Disclosure through the Criminal Records Bureau, to establish any criminal record, upon offer of appointment and your signature at the end of this form will be regarded as signifying your agreement that this may be done. Such Disclosures will not be used unfairly and a criminal record will not necessarily be a bar to obtaining a position. You should indicate whether you have any convictions
Data Protection

I agree that the information given in my application may be used for purposes registered under the Data Protection Act 1998, and I consent to the information being stored on manual and computerised files for relevant employment related purposes.

Declaration

I confirm that the information I have given on this application form is accurate and correct to the best of my knowledge. I consent to The Anvil Trust Ltd checking any of the details on this form. I understand that the supply of inaccurate or incorrect information, or omission of any material information from this application form, may result in the withdrawal of any offer of employment, or termination of employment.

Signed:______Date:______

Equal Opportunities Monitoring Form

Private & Confidential

The Anvil Trust Limited is an equal opportunities employer. In order to ensure that The Trust meets the requirements within its equal opportunities policy, all applicants are asked to place a tick in the relevant boxes below and complete the required details. This information will be used solely for monitoring purposes and will be treated as confidential. It will be separated from your completed application form before short-listing of candidates takes place. Thank you for your co-operation.

APPLICATION FOR THE POST OF:
Gender:Male Female
Age Group: Under 19 20 – 34 35 – 49 50 – 64 65+
ETHNICITY
Which is your ethnic group? Choose ONE section from A to E, and then tick the appropriate box to indicate your cultural background.
AWhiteBDual Heritage :
White BritishBlack Caribbean and White 
White Irish Black African and White 
Any other White Asian and White 
background Chinese and White 
CAsian or British Asian:D Black or Black British:
IndianBlack or Black British Caribbean
PakistaniBlack or Black British African
BangladeshiAny other Black background
Any other Asian background
EChinese or other ethnic group:
Chinese
Other Ethnic Group Please specify:

It is our policy to actively encourage applicants from people with disabilities. If you meet the minimum criteria for the job, you will be interviewed. All applicants will be considered only on their abilities.

Do you consider yourself to have a disability?Yes / No

FOR OFFICE USE ONLY: Equal opportunities monitoring No:

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