Mr Mrs Miss Ms Other (please tick)

Please supply a complete employment history starting with your most recent job. Any gaps in employment must be accounted for. Please use additional sheets if necessary.

Employer’s Name and Address / Job Title and Main Duties / From / To / Salary / Reason for leaving
School/College name and address / From / To / Qualifications / Grade

Skills/Training

Please give brief details of any other relevant courses and/or training undertaken or currently being studied

Membership of any professional societies, details of articles published or other activities

Experience of church life and your personal faith

If the job description has an occupational requirement for the position to be filled by a Christian, tell us a little of your experience of church life and your personal faith.

Statement in support of your application

You may wish to include relevant education/knowledge, skills, experience, personal qualities and achievements. Please ensure that the details recorded are relevant to the person specification and job description of the post applied for. Use the space below or a separate sheet.

Right to work in the UK

Under Section 8 of the Asylum and Immigration Act 1996, it is a criminal offence to employ an individual who does not have permission to work in the UK. Therefore, all offers of employmentare made subject to the production of documentary evidence of such permission, e.g. passport or other Home Office authorised documentation.

Are you able to provide such documentary evidence? Yes □No □

Driving

Do you hold a valid UK driver’s licence? Yes □No □

Have you a car available for use in connection with your work? Yes □No□

Health

Are you in good health? Yes □No□

How many days sick leave have you taken in the last 2 years?

Do you have, or have you had, any medical conditions that might affect your

performance in undertaking the post being applied for? Yes □No □

If you answered yes to the last question, please provide further details of your condition/disability, and any reasonable adjustments that you feel should be made to assist you in the recruitment process or the job itself.

Criminal Record

Do you have a criminal record? Yes □No □

Are there any criminal charges pending against you? Yes □No □

Have you any unspent convictions as defined by the Rehabilitation of
Offenders Act 1974? Yes □No □

Have you been disqualified in any way from working, or having contact
with or near children? Yes □No □

If you answered yes to any of the above questions please give details below

Please note that in order to comply with our Child Protection Policy we will require an employee to undertake a Disclosure and Barring Service check if the role is considered to be a regulated activity.

Please give the name, address and telephone number of two referees (who should not be related to you), one of whom must be your present or most recent employer. If the job description has an occupational requirement for the position to be filled by a Christian, one of the referees should be your church leader.

Mr Mrs Miss Ms Other (please tick)

Interview

Please give any dates or times when you would not be available for interview if invited.

Declaration

I declare that to the best of my knowledge the information provided on this form is accurate, truthful and complete.

I understand that the giving of false information may result in the termination of any contract of employment offered.

I understand that the detail supplied on this form may be stored on a computer system and will be used solely for the purpose of processing my application.