Post applied for: / Transport Booking Officer / Date:

Daventry Area Community Transport Application Form

Please complete this form fully, handwritten, using black or blue ink . C.V’s will be accepted supporting the application, but are not a substitute for completing this application. Incomplete applications or applications received after the closing date of 9am 8th April 2013 will not be considered. If selected, you will need to be available for interview on either 17th or 18th April 2013
Please send completed application form to DACT, The Abbey, Market Square, Daventry, Northants NN11 4XG
THE INFORMATION SUPPLIED ON THIS FORM WILL BE TREATED IN COMPLETE CONFIDENCE

Section 1 Personal Details

Mr/Mrs/Miss/Ms
Last name: / First name:
Address:
Postcode:
Daytime telephone no:
Mobile telephone no:
E-mail address:
Date of birth
Do you know of any health or other reasons which could affect your ability to undertake the duties and responsibilities of this appointment?
/ YES
/ NO
/
If yes, please give brief details:-
How much time off, due to to sickness, have you had in the last two years?
...... (days) /

Driving licence

Do you hold a full driving licence valid in the UK? /

Yes

/

No

If you hold a Current Driving Licence and have any endorsements, please list them here with date of offence, category of endorsement & penalty fine.
Rehabilitation of Offenders Act (1974)
This post is offered subject to a satisfactory enhanced Disclosure and Barring Service (DBS) check and is exempt from the provision of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are not entitled to withhold information when asked about convictions which for other purposes are ‘spent’ under the provision of the Act. In the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action. Information given will be completely confidential.
If you would like to discuss any conviction, caution or reprimand that you think may affect your application, please give details / dates of offence(s) and sentence:

If appointed to this post, please advise your earliest start date. Give period of notice if applicable.

Do you have any outstanding holiday commitments. If so, please give dates

Section 2 Present Employment

Present Employment (If now unemployed give details of last employer)
Name of employer:
Address:
Postcode:
Position / Job title:
Date of appointment: / Salary:
Department:
Brief description of duties:
Notice period: / Last day of service
(if no longer employed):
Reason for leaving
(if no longer employed):

Section 3 Previous Employment

Previous Employment within the last 10 years – (most recent employer first)
Name of employer:
Address:

Postcode

Position held:
Summary of duties:
Reason for leaving:
Name of employer:
Address:

Postcode

Position held:
Summary of duties:
Reason for leaving:
Name of employer:
Address:

Postcode

Position held:
Summary of duties:
Reason for leaving: / Continue on a separate sheet if necessary

Section 4 Education

Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first:
College or University / Course / Qualifications and grades obtained
School / Subjects / Qualifications and grades obtained
Continue on a separate sheet if necessary

Professional or Management Qualifications

Please give details
Professional /
Management Qualifications / Course Details
Continue on a separate sheet if necessary

Section 5 Training and Development

Please give details of any training and development or non-qualification based courses which support your application. Include any ‘on the job’ training as well as formal courses.
Title of Training Programme or Course / Duration of Course
Continue on a separate sheet if necessary

Section 6 Personal Statement

Abilities, skills, knowledge and experience
Please use this section to demonstrate why you think you would be suitable for the post by reference to the job description and person specification (and by giving examples and case studies). Please include all relevant information, whether obtained through formal employment or voluntary/leisure activities. You need to explain how you meet each of the person specification points and provide examples from your previous experience. Do not forget to present this in relation to the job description Attach and label any additional sheets used.
Continue on a separate sheet if necessary
Statement to be Signed by the Applicant
Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered.

I acknowledge that DACT is under a duty to protect the Service Users it supports and to this end I agree it may use information provided on this form for the prevention and detection of crime and it may share this information with other bodies solely for these purposes. I hereby give consent to such collection, storage and processing of my personal data and I agree that the information given on this form may be used for data registration purposes.

I hereby certify that:
·  all the information given by me on this form is correct to the best of my knowledge
·  all questions relating to me have been accurately and fully answered
·  I possess all the qualifications which I claim to hold
·  I have read and, if appointed, am prepared to accept the details as listed in the attached job description.
Signed: / Date:

Section 7 References

/ /
Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are. Please do not put down family members or people you live with as referees.
Reference 1 / Reference 2
Name: / Name:
Position
(job title): / Position
(job title):
Work Relationship: / Work Relationship:
Organisation: / Organisation:
Address: / Address:
Postcode: / Postcode:
Telephone no: / Telephone no:
E-mail: / E-mail:

If either of these referees are not current or former employers, please give a brief explanation below explaining your relationship and the reason for listing them as a referee:

References

We will take up references once you have been interviewed and provisionally offered the post. Please make sure that you have given the full contact details of your referees so that this does not delay processing reference requests.

You will only be confirmed in the post once we are satisfied with the information received from your referees.