Mid- Ulster Victims EmpowermentProject

APPLICATION FORM

Post applying for:- Project Worker ( Part-Time )

(Please use black ink)

Personal particulars:

Title:

Surname:

First names:

Address:

Postcode:

Telephone No: (daytime) (evening)

Mobile No
Email Address

Qualifications:

Education:
Examinations taken Results Year
Relevant Training to Date:
Course Year
Previous Jobs, working or voluntary(only list two posts that would be relevant to the post, starting with your most recent)
1. Name & Address of Employer




Worked from – to (dates)
Description of duties:




Reason for Leaving:
2. Name & Address of Employer




Worked from – to (dates)
Description of duties:




Reason for leaving:

How much notice do you require to give your present employer?

If appointed when could you commence work?
Supporting Statement
(a)Based on the Job Description, please provide specific examples how you meet the essential criteria for the post.
(b)Outline (using examples) how your past skills and experiences match the Job Description regarding the post.
(Please continued on pages 4 - 6 if necessary, but no more than 3 A4 pages in total for the supporting statement, )
Your Health
Give details of any serious illnesses or disabilities that may require special arrangements during the interview procedure or to assist you to work effectively in the office environment.




State the number of days off ill during the last year. Give reasons for absence.



Driving LicenceDo you hold a current full driving licence? Yes / N0
Please supply the name and address of two referees. Where appropriate at least one should be from your present or last employment.
Name: Name:
Address: Address:


Tel No: Tel No:

Occupation/ Job Title: Occupation/Job Title:

I certify that all particulars are true and correct to the best of my knowledge and belief. If relevant facts have been wilfully suppressed the employer may terminate my contract or any offer of employment may be withdrawn.
Signed: Date:

Thank you for taking time to fill in this application form. May I request that you return all information no later than Tuesday27th August before 12.00noon any application returned after this time will be considered void.

Please note interviews will take place on Monday 2nd September.

Return Application to:-

Mary Hogg

Company Secretary

Mid Ulster Victims Empowerment Project

C/O Positive Steps Community Centre

2c Park Avenue

Cookstown

Co Tyrone

BT80 8AH

Mid Ulster Empowerment Project

Positive Steps Community Centre

2c Park Avenue

Cookstown

Co. Tyrone

BT80 8AH

Given the nature of the job for which you are applying, and the fact that, it involves close work with adults who sometimes may be vulnerable, the Rehabilitation of Offenders Order does not apply and you are expected to declare any spent convictions. However, having previous convictions may not affect your application. Any information given will be treated as strictly confidential and will be considered only in relation to this application.

Please answer Yes or No

  1. Have you ever been convicted of a criminal offence (including motoring offences)?
  1. Are there any cases pending against you?
  1. Have you any spent convictions?

If you have answered yes to any of the above questions please give details in the box below.

Note - convictions do not necessarily debar an applicant from obtaining employment.

MONITORING OF EQUAL OPPORTUNITY

We are an equal opportunities employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of gender, marital status, religious belief, political opinion, disability, race, ethnic origin or age. You are therefore asked to complete this monitoring form. Access to this will be strictly controlled and will not be available to those considering your application for employment.

Gender:Male Female

Ethnic Background:

White European White Other

Black Caribbean Black African

Black Other Bangladeshi

Indian Pakistani

Chinese Irish Traveller

Other

Disability:

The Disability Discrimination Act 1996 states a person has a disability if he/she has a physical or mental impairment which has a substantial and long tern adverse effect on his/her ability to carry out normal day-to-day activities.

Having read this definition, do you consider you have a disability?

YesNo

Employment:

Full-time Part-time Student/Trainee

Perceived Religious Affiliation:

I am a member of the Roman Catholic Community

I am a member of the Protestant Community

I am a member of neither the Protestant or Roman Catholic Community

1