APPLICATION FORM

Please complete this form in BLACK INK and continue on a separate sheet where necessary

Position applied for :……………………………………………………Job Ref No:………….

Location (if applicable)……………………………………………………………………………..

How did you hear of this vacancy?……………………………………………………………

PRESENT EMPLOYMENT DETAILS

Name and Address ofEmployer
Telephone Number / Basic Salary/Wage
£ per annum/per week
Additions
£ per annum/per week
Grade (if appropriate)
Post held / Date Appointed
Length of notice required to
terminate appointment
Brief description of current duties

EMPLOYMENT AND CAREER HISTORY

Dates
From/To
/ Employer / Position Held / Salary/Grade / Reason for leaving

EXPERIENCE

Please give details of any previous experience, relating to this application(either work-related or general/

life experience), including why you think it is relevant to this application – please refer to the job description and person specification.

EDUCATION AND QUALIFICATIONS

Schools / From To / Examination Results
(Subjects, Level & Grades)
Further Education
(full and part time)
Courses attended
Qualifications (including membership of professional bodies)

PERSONAL DETAILS

First Name / Last Name
Permanent address / Telephone number(s)
May we ring you at work?
Email address / Do you need to hold a work permit? / Yes / No
NI No: / Do you have a current driving licence? / Yes / No
Do you consider yourself to have a disability?Yes / No / Prefer not to State

REFERENCES

Please give the names and addresses of two people who can provide a reference for you. They should both be employment referees and should include your present or most recent employer (or college/school). It would be helpful if you could also provide a contact telephone number for each.
Please indicate if you do not wish us to take references prior to interview.
(a) (b)

DECLARATION

I declare that to the best of my knowledge the information herein is true
Signed……………………………………………………………… Date…………………………………………
Send completed form tothe HR Department, Sussex Oakleaf, Orchard House,1-2 Gleneagles Court, Brighton Road, Crawley, West Sussex RH10 6AD or email to

Equality and Diversity form

Gender:  Male  Female Prefer not to state
Age  16-25  26-35  36-45  46-55  56-64  65 and over
 Prefer not to state
Ethnic Origin
 White: British /  Black/Black British: Caribbean
 White: Irish /  Black/Black British: African
 White: Other (please specify) /  Black/Black British: Other (please specify)
 Mixed: White and Black Caribbean /  Asian/Asian British: Indian
 Mixed: White and Black African /  Asian/Asian British: Pakistani
 Mixed: White and Asian /  Asian/Asian British: Bangladeshi
 Mixed: Other (please specify) /  Asian/Asian British: Other (please specify)
 Chinese/other ethnic group: Chinese /  Prefer not to state
 Chinese/other ethnic group :Other (please specify)
Sexual Orientation
 Bisexual /  Gay man /  Gay woman/ Lesbian
 Heterosexual/straight /  Transgender /  Other (please specify)
 Prefer not to state
Religion
 Bahá’i /  Jain /  No religion
 Buddhist /  Jewish /  Other (please specify)
 Christian /  Muslim /  Prefer not to state
 Hindu /  Sikh
Do you consider yourself to have a disability*?
 Yes  No  Prefer not to state
If yes, please state from one of the following:
 Physical Disability /  Visual Impairment /  Hearing Impairment
 Speech Impairment /  Learning Disability /  Mental Illness

*Please refer to the explanatory notes when completing this form.

EQUAL OPPORTUNITIES EXPLANATORY NOTES

Sussex Oakleaf Housing Association has an Equal Opportunities policy. This means that we welcome applications from men and women regardless of colour, race, nationality ethnic or national origin, marital status, disability, age, sexual orientation, political or religious belief. We undertake to treat all job applicants and employees fairly.

In order to ensure that we are not discriminating unfairly and to measure how effective our Equal Opportunities policy is (and for no other purpose) we monitor all job applicants and employees by ethnic origin, gender, sexual orientation, disability and age. We ask you to assist us in eliminating unfair discrimination and achieving equal opportunities by completing the Monitoring Form. Please be assured that the information provided is NOT used for selection purposes and will NOT be seen by the recruitment panel. This information will remain anonymous until you have been appointed to a post.

Ethnic Origin

Ethnic origin is not about place of birth or citizenship, but about colour and cultural identity. UK citizens can belong to any of the groups indicated.

White

Persons born in Europe, or whose ancestors were of European origin (except Irish)

Irish

Persons born in Ireland, or whose recent ancestors are of Irish origin.

White - Other (please specify)

Persons whose ethnic origin, or that of recent ancestors, is other than European or Irish.

Black African

Persons born in Africa, or whose recent ancestors are of African origin. This does not include persons of Asian origin who have settled in Africa.

Black Caribbean

Persons born in the Caribbean, or whose recent ancestors are of Caribbean origin.

Black – Other (please specify)

Black people whose ethnic origin, or that of their recent ancestors, is other than African or Caribbean

Indian

Persons born in India, or whose recent ancestors are of Indian origin.

Bangladeshi

Persons born in Bangladesh, or whose recent ancestors are of Bangladeshi origin.

Pakistani

Persons born in Pakistan, or whose recent ancestors are of Pakistani origin

Asian – Other (please specify)

Asian people whose ethnic origin, or that of their recent ancestors, is other than the above.

Chinese

Persons born in China, or whose recent ancestors are of Chinese origin.

DISABILITY DEFINITIONS

The Disability Discrimination Act 1995 defines a disabled person as someone who has, or has had, a condition which substantially impairs their ability to carry out normal day-to-day activities, and which has lasted, or is likely to last, for a period of 12 months or more.

In addition to telling us whether or not you have a disability, it would be helpful if you would provide further details overleaf. This will give us some indication of workplace adjustments we may need to consider if you are appointed. The following list may assist you and is not exhaustive:

Physical Disability

Includes conditions affecting mobility, manual dexterity, physical co-ordination, continence and ability to lift, carry or otherwise move everyday objects.

Visual Impairment

Includes blind and visually impaired people expect where visual impairment is corrected, or capable of being corrected, by the use of spectacles or contact lenses.

Hearing Impairment

Includes those people who are deaf (from birth or early childhood), deafened and hard of hearing.

Speech Impairment

Includes all conditions which effect a person’s ability to express themselves clearly through speech.

Learning Disability

Includes all conditions which impair memory or ability to concentrate, learn or understand, or which effect the perception of the risk of physical danger.

Mental Illness

Includes all well recognised conditions which substantially impair the performance of any normal day-to-day activities.

REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER 1986 FORM

Name (in full, please print)………………………………………………………………………

Post applied for:………………………………………………………………………………….

We would draw your attention to the following statement:

“Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1986. Applicants are, therefore, not entitled to withhold information about convictions and cautions which for other purposes are “spent” under provisions of the Act.”

The following questions must be answered by all applicants. You should provide details about all pending prosecutions, convictions, cautions and bind-over orders (including those which took place whilst a juvenile) and the information should include the approximate date, the offence and the court or police force which dealt with the offence. If you have any doubt at all about what to include on this form you should seek advice. The form should be returned with your application form. *

DO YOU HAVE A PROSECUTION PENDING OR HAVE YOU EVER BEEN CONVICTED AT A COURT OR CAUTIONED BY THE POLICE FOR ANY OFFENCE?

YES/NO?

IF YES, PLEASE GIVE DETAILS AND DATES IN THE SPACE BELOW:

DECLARATION

I understand that if it is found that I have withheld information or included any false or misleading information above I will be disqualified from appointment, or if already appointed, this will render me liable to dismissal without notice. I understand that the information will be kept securely by the Company.

I hereby declare that the information I have provided is accurate.

Date…………………….... Signed…………………………………………….………………

Full name (please print)……………………………………………………………………….

For Office Use Only

Accepted for shortlisting: Signed……………………………………………………………

Date…………………….. Designation……………………………………………………..

*’The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service website’.