This application process is open now for immediate start. Email to:Andy Wheeler arity: 519825

Position applied for

PERSONAL DETAILS

First name / Surname
Address
Post code / Telephone
Work
Home
Date of birth

EDUCATION

Details of secondary school / Dates / Qualifications
or further education / From - To

TRAINING/ OTHER SPORTING QUALIFICATIONS

Please list any other training received, skills or courses attended. / Dates

RELEVANT EMPLOYMENT HISTORY & EXPERIENCE

Employer/organisation
(most recent first) / Position held and brief description of duties/responsibilities / Dates
From - To / Reasons for leaving
and final salary

OUTSIDE INTERESTS

MEDICAL HISTORY

Give a brief outline of any health problems or disabilities.

ADDITIONAL INFORMATION

Do you hold a current, valid full driving licence? Yes / No
Do you have access around Worcester City Yes / No
Please give details of any paid or voluntary work you have undertaken with children or young people before?
If you have NOT undertaken any paid or voluntary work with children or young people before please sign here:
Signature: ……………………………………………………...

NAMES AND ADDRESSES OF TWO REFEREES

(Including your previous employer and someone who has knowledge of any work or volunteering previously done with children and young people.)

Name
Address
Tel no.
Job title / Name
Address
Tel no.
Job title
Do you wish to be consulted before these referees are approached? Yes / No
Date you could start employment.

Because the work involves contact with children and young people you are required by the Rehabilitation of Offenders Act 1974 to declare all convictions, including spent convictions. Please sign one of the following statements as applicable.

1.I declare that I have no criminal convictionsfor offences involving children and/or young people and any unspent criminal convictions for any offence involving dishonesty, deception or assault against a person.

Signed: ……………………………………..………………

2.If short listed I will provide a list of all convictions in a separate sealed envelope to the Development Manager.

Signed: ……………………………………..………………

Having a conviction will not necessarily prevent you from working forDisability Sport Worcester. I consent to a criminal record check if this is required and agree to abide by the relevant policies and procedures. By signing this form I agree to the details recorded here being held on computer by the Charity.

I understand that if any information I have provided is found to be untrue any offer may be withdrawn or any contract of Employment may be terminated.

Signed: ...... Date: ......

Additional information

Please give any further information you wish in support of your application.