Cvs Will Not Be Considered

IN CONFIDENCE
NAME:
POSITION APPLIED FOR:

The information that you supply in this application form will be used to decide whether to invite you to an interview.

While all sections may not be relevant to you personally, you should complete the form as fully and as accurately as possible to enable your application to be given full consideration.

CVs will not be considered

When completed this form should be returned to:

HR department

The Prince & Princess of Wales Hospice

71 Carlton Place

Glasgow

G5 9TD

Applications received after this will NOT be considered

Please note that standard first class post may not be enough to cover the cost of postage of your completed application

If you have not heard from the Hospice within 2 weeks of the closing date, then please assume that your application has been unsuccessful or that your application was received after the closing date stated above.

The Information provided within your application form will be processed in accordance with the Data Protection Act 1998.

Personal information
Full name:
Home address:
Postcode:
Home telephone number: Business telephone number:
Mobile telephone number: Email address:
May we contact you at work?: yes/no
Referees
Please give details of two referees. They should be qualified to comment on your ability and experience for this appointment and should include a referee from your current or most recent employer. The Prince & Princess of Wales Hospice does not accept references from family members.
If you do not wish your current employer to be approached before a verbal offer has been made, please indicate in the box below.
Name:
Job Title:
Company:
Address:
Postcode:
Email:
Tel No:
Fax No:
Relationship to you:
Do not approach:  / Name:
Job Title:
Company:
Address:
Postcode:
Email:
Tel No:
Fax No:
Relationship to you:
Do not approach: 
Secondary education (please list subjects passed)
Standard/’O’ grade or equivalent / Grade / Higher grade or equivalent / Grade
Further education
University or further education establishment / Course(s) & subjects studied / Degrees, diplomas, certificates obtained
Professional qualifications
Name of awarding body / Qualifications obtained, membership of professional institution etc
Training courses
(please give details of any relevant short courses or training undertaken)
Course(s) undertaken / Provider(s)
Computer skills (please detail your experience)
Driving licence

Do you possess a full current driving licence? YES/NO (please delete as appropriate)

Is it Clean? YES/NO If no please give details:

Asylum & Immigration Act 1996

The Asylum & Immigration Act 1996 makes it an offence to employ anyone who is not entitled to live or work in the UK. All applicants selected for interview will be required to provide evidence that they are entitled to live and work in the UK. Appropriate documentation may include the original of your current passport, or birth/marriage certificate and National Insurance Number (found on NI Card/P45/P60 etc)

Do you require a work permit? YES/NO (please delete as appropriate)

Present or most recent employment
Name & address of employer:
Date from: / Date to:
Position held: / Salary & other benefits/payments:
Notice required: / Reason for leaving:
Nature of post (please describe your main duties):
Employment history (list in order with most recent post first)
Name & address of previous employer(s) / From
month/year / To
month/year / Position held, main duties and reason for leaving

Please continue on a separate sheet if necessary.

Additional information
Please provide any relevant information not covered elsewhere on this form, which may include other activities e.g. voluntary work, major achievements, projects to date and indicate how this will enable you to contribute further to this post.
Assistance for people with disabilities
Do you consider that you have a disability? YES/NO
If YES, are there any arrangements we can make for you if you are called to interview or if successfully employed? Please give details below:
Relationship to staff members
If you are related to any member of staff of The Prince & Princess of Wales Hospice or anyone who has been employed as a staff member in the last 12 months, please provide details:
Declaration

I certify that the above information is correct. I understand that my application may be rejected or that I may be dismissed for withholding relevant details or giving false information. I understand that any employment offer will be subject to satisfactory references, disclosure check (where appropriate), occupational health check and professional registration if appropriate. I have read the information on data protection and agree to my details being used in the specified ways.

Signed: ______Date: ______

Equal opportunities monitoring form

Both sides of this form must be completed and returned along with your application form. Where you would prefer not to answer a particular question, you can tick the relevant box. The data collected in this form will be used only to review and report on the effectiveness of the Hospice’s equal opportunities policies. The information provided on this form will be treated in the strictest confidence and held securely within the HR Department and will not be used in the shortlisting process.

NOTE: Where did you hear about this post? ------

1. GENDER IDENTITY

How would you describe your gender?

Female

Male

I prefer not to answer this question

Would you consider yourself to be transgender?

Yes

No

I prefer not to answer this question

2. ETHNIC GROUP

What is your ethnic group?

For this question, please choose one section from A to E and then tick the appropriate box in that

section in order to indicate your ethnic group.

A. White

Scottish

Other British

Irish

Any other White background- Please specify

B. Mixed

Any mixed background

C. Asian, Asian Scottish or Asian British

Indian

Pakistani

Bangladeshi

Chinese

Other Asian background - Please specify

D. Black, Black Scottish or Black British

Caribbean

African

Other Black background - Please specify

E. Other ethnic background

Any other ethnic background - Please specify

I prefer not to answer this question

3. AGE

What is your age?

Please specify age (in years)

I prefer not to answer this question

4. RELIGION

Which of the following religions, religious denominations or bodies do you currently belong to? If you do not belong to any of these, please tick “None”.

None

Church of Scotland

Roman Catholic

Other Christian - Please specify

Buddhist

Hindu

Jewish

Muslim

Sikh

Other religion - Please specify

I prefer not to answer this question

5. SEXUAL ORIENTATION

How would you describe your sexual orientation?

Heterosexual

Gay Man

Lesbian

Bisexual Man

Bisexual Woman

Other - Please specify

I prefer not to answer this question

6. DISABILITY
The Disability Discrimination Act 1995 defines disability as “a physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”.
Do you consider that you have a disability?
(a)  Yes
(b)  No
(c)  I prefer not to answer this question
CRIMINAL CONVICTION DECLARATION

Through your employment with The Prince and Princess of Wales Hospice you may be involved in working with children, young people and vulnerable adults. It is the policy of the Hospice to carry out disclosure checks on all individuals who work within the Hospice building. A copy of the policy is available on request. The information requested below is only required as a preventative measure against abuse of children, young people and vulnerable adults and will not be used for other purposes. It will be treated in the strictest of confidence and will not be used to discriminate against you unfairly. All convictions must be declared as exemption under the rehabilitation of offenders act 1974 applies.

A. Personal details

Full name

Address and postcode

Date of birth
Occupation
Telephone number
B. Declaration
a Have you ever been convicted of a criminal offence /

YES/NO

b Do you have a court appearance pending or have you been charged by the police for a criminal offence. / YES/NO
C. Additional details
Date / Court / Details of offence / Sentence
D. I certify that:

a. I have not withheld information that may affect my application for employment.

b. I understand that false information or omissions may lead to dismissal or termination of contract.

Print Name: ______

Signed: ______

Date: ______

Guidance notes on completing the application form

1.  The form should be completed in black or blue ink for photocopying purposes.
2.  Please continue on separate sheets if necessary to answer your questions fully, ensuring that these sheets are marked with your name and the post applied for.
3.  One of your references should be your line manager from your present or most recent employer. If you have not been employed or have been out of employment for a long time, you may wish to give the name of someone who knows you sufficiently well to confirm the information you have given and to comment on your ability to do this job.
4.  The enclosed job description details the minimum knowledge and skills required for this post. When short listing for interview, the selection panel will only consider the information contained in your application form and assess this against the criteria.
5.  It is not the responsibility of the selection panel to make assumptions about the nature of the work you have done from a list of job titles. It is therefore important that you use the space provided to detail your experience and skills. Neither is it enough for you just to state that you meet the requirements; you must demonstrate this to the panel. Work, paid or voluntary, is not the only means of showing that you meet the requirements of the post. Life experience and skills are just as valid, so long as you are able to demonstrate this.
6.  If you are short listed for interview, the selection panel will wish to discuss the areas covered in the job description in more detail.
7.  It is the policy of the hospice to carry out criminal records checks on any member of staff who may in the course of their work come into contact with children, young people and vulnerable adults. A copy of this policy is available on request. This information is used solely for this purpose and will not be used to discriminate against you unfairly. Please complete the criminal conviction declaration form included in your application pack and return to us along with your application form.
8.  Any offer of employment is subject to occupational health check, disclosure check (where appropriate), reference checks and appropriate professional registration checks.
9.  If you have a disability and require any assistance with completing this application form please phone the hospice on 0141 429 5599 and ask to speak to the HR department to request this.
10.  Any data about you will be held in completely secure conditions, with access restricted to those involved in dealing with your application and in the selection process. Equal opportunities information will be used to monitor the effectiveness of the hospice equal opportunities policy. We will be unable to process your application unless we can use your data in the ways described above. By signing and submitting the application form you are agreeing to the processing of your data in these ways.
11.  Please return this form by the closing date outlined in the accompanying letter and clearly marked on the application form to The Prince & Princess of Wales Hospice at 71 Carlton Place, Glasgow, G5 9TD.
12.  The hospice is an equal opportunities employer and is committed to ensuring that all job applicants are treated on a fair and equitable basis. If you think you have been treated unfairly you have the right to make a complaint. Complaints should be made in writing to the chief executive within 5 working days of receiving a decision from the hospice. Your complaint will be dealt with in line with the hospice complaints policy and procedures.