For Official Use Only - Vacancy Details

APPLICATION FOR EMPLOYMENT

Father Hudson’s Society is a Social Care Agency working within the Archdiocese of Birmingham. The Society is committed to equal opportunities in employment and welcomes your application irrespective of your gender, race, disability, colour, ethnic origin, nationality, sexual orientation, marital status, religion or age.

For Official Use Only - Vacancy Details

Post Reference No.:P1106 Application Form No.: / Returned Date:
Job Title:Female Volunteer Coordinator / Shortlist: Yes/No
Location:Anawim, Balsall Heath, Birmingham / Appoint: Yes/No

Before completing this form, please consult the Notes for Guidance information.

1Personal Details

Title: Mr  Mrs  Miss  Ms  Other (please state)
Last name: …………………………………………………….. National Insurance No. ……………………….
First name(s): …………………………………….…………… Daytime tel no: ………………………..………
Address: ……………………………………………………….
…………………………………………………………………… Evening tel no: ………………………………
Town/City: …………………………………………………….. Mobile tel no: …………………………………
County: …………………………………………………………
Postcode: ……………………………………………………… Email: …………………………………………
Name of current Anawim / Father Hudson’s Care employee who advised you of this post, if applicable.
…………………………………………………………………………………………………………….

2General Information

a) Do you require a work permit or similar, to legally work/study in the UK? Yes  No 
b) Please indicate membership of any organisation(s) relevant to this job. ………………………………
c) Do you consider yourself to have a disability? Yes  No 
If Yes, please let us have any relevant information
d) Do you have a current driving licence? Yes  No 
e) Please answer the following if having a licence is a requirement of the post.
Licence type: Provisional  Full  Is the licence endorsed? Yes  No 
If yes, please give brief details …………………………………………………………………………..

3Education/Qualifications

From / To / Secondary School/
College/University/Professional / Examinations taken or to be taken / Results & Grades / Date gained
Mth/Yr / Mth/Yr / Mth/Yr
/ / / / /
/ / / / /
/ / / / /
/ / / / /
/ / / / /

4Training

Please list any course(s) you have undertaken relevant to the job and/or specified on the person specification.

Year / Organising body / Course title / Length

5Present or Most Recent Employment (if any)

Job Title: / Date started: / /
Employer: / Date left: / /
Address: ……………………………………………………
…………………………………………………… / Reasons for leaving/wishing to leave:
…………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Notice Period:
Town/City: …………………………………………………
County: ..………………………………………………..

Postcode: ………………………
Salary: £
Nature of work/responsibilities: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Past Employment (minimum of previous 5 years) and Experience (if any). Include voluntary or other relevant experience.

5Continued

From / To / Employer or Organisation
(full name and address) / Job title or type of work undertaken / Reason for change
Mth/Yr / Mth/Yr
…. / …. / …. / …. / …………………………………………………………………………………………………………………………………………………… / ………………………………………………………………………………………………………………………………………… / …………………………………………………………………………
…. / …. / …. / … / ……………………………………………………………………………………………………………………………………………………
…………………………………… / ………………………………………………………………………………………………………………………………………………………………………….. / ……………………………………………………………………………………………
…. / … / …. / … / ……………………………………………………………………………………………………………………………………………………………………………………….. / ………………………………………………………………………………………………………………………………………………………………………….. / ……………………………………………………………………………………………
…. / …. / …. / … / ……………………………………………………………………………………………………………………………………………………………………………………….. / ………………………………………………………………………………………………………………………………………………………………………….. / ………………………………………………………………………………………………………………………
…. / … / …. / … / ……………………………………………………………………………………………………………………………………………………………………………………….. / ………………………………………………………………………………………………………………………………………………………………………….. / ……………………………………………………………………………………………………………………..
…. / … / …. / … / ……………………………………………………………………………………………………………………………………………………………………………………….. / ………………………………………………………………………………………………………………………………………………………………………….. / ……………………………………………………………………………………………………………………..
…. / … / …. / … / ……………………………………………………………………………………………………………………………………………………………………………………….. / ………………………………………………………………………………………………………………………………………………………………………….. / ……………………………………………………………………………………………………………………..

6References

Please give details of two referees one of which must be your current or most recent employer. (See Guidance Notes)

1 / 2
Name of Referee: ………………………………….
Full Address: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………..
Postcode: …………………………………………..
Telephone Number: ……………………………….
Job Title: ……………………………………………
E Mail: ……………………………………………….
How long known to you: ………………………….
Relationship to you: ……………………………… / Name of Referee: ………………………………
Full Address: ..………………………………………………………………………………………………………….……………………………………………….………………………………………………………….
…………………………………………………….
Postcode: ……………………………………….
Telephone Number: ……………………………
Job Title: ………………………………………..
E Mail: ……………………………………………
How long known to you: ………………………..
Relationship to you: …………………………….

7Other information in support of your application

Please detail any experience and skills, which demonstrate your ability to carry out the job.

It is important that you refer to the ‘Guidance Notes for Applicants’ when completing this section.

You may continue on the next page if you wish.

7Other information in support of your application - continued

8Criminal Convictions

Please see Guidance Notes

a) Have you been convicted of a criminal offence? Yes  No 
If Yes, please give brief details

a) b) If the post for which you are applying is‘excepted’ from the Rehabilitation of Offenders Act 1974

(see job description) in the event of you being shortlisted, you will be asked to complete a

confidential declaration regarding any criminal convictions, whether spent or unspent, cautions,

reprimands and final warnings and any other information that may have a bearing on your suitability.

9Data Protection Act 1998 – Consent and Certification of details

The information detailed in this application form and accompanying monitoring information, will be used to monitor the effectiveness of Father Hudson’s Care policies and practices, in particular its Equal Opportunities. This monitoring is for statistical purposes only and you will not be identifiable from this process. However, your personal details contained in the application form, may be used in the prevention and detection of fraud. Where this occurs you will be identifiable. The information may be disclosed to the following third parties:

Government/Statutory Agencies

Law Enforcement Authorities.

Giving false information will result in your application not being pursued or your contract being terminated, without notice, if you have already been appointed to the job.

Application forms of unsuccessful candidates will be destroyed after six months from the closing date for the post.

I, (print name): …………………………………………………..

Consent to Father Hudson’s Care recording and processing the information detailed in this application form. I understand that this information may be used by Father Hudson’s Care in pursuance of its business purposes and my consent is conditional upon Father Hudson’s complying with their obligations under the Data Protection Act 1998.

I also confirm that the information contained in this application form is complete and correct and that inaccurate or misleading statements may be sufficient for you to cancel any agreement or contract made or my being dismissed without notice.

Signature: ……………………………………………Date: ……………………………………………

10Recruitment Monitoring

Post Reference Number: P1039

To help us monitor our Equal Opportunities in Employment please provide the following information

and return this form with your completed application form.

Please tick or complete the following boxes as appropriate:

GenderMale 

Female

Age GroupUnder 25

26 – 34

35 – 49

Over 50

Where did you see the job advertised?Newspaper (Please Specify) …………………………..

Professional Journal (Please Specify) …..……………

Internet/Website (Please Specify) ………………….…

Other (Please Specify) ………………………………….

Do you consider yourself to have a disability as defined by the

Disability Discrimination Act 1995? Yes  No 

I would describe my ethnic origin as:

WhiteBritish

Irish

Any other White background

Black or Black BritishCaribbean

African

Any other Black background

Asian or Asian BritishBangladeshi

Indian

Pakistani

Any other Asian background 

MixedWhite and Black Caribbean

White and Asian

White and Black African

Any other mixed background

Other ethnic groups Chinese

Any other ethnic background

Religion or Religious beliefs (if any) Please specify: ………………………………………….

I do not wish to specify

Application form June 2015