Application Form

PLEASE READ CAREFULLY BEFORE COMPLETING THEN COMPLETE IN BLACK INK

1. VACANCY DETAILS
POST APPLIED FOR / Senior Development Worker
LOCATION / Fox Street Community, Preston
2. PERSONAL DETAILS
SURNAME
ALL FORENAMES
TITLE
ADDRESS & POSTCODE
TELEPHONE NO / HOME:
MOBILE:
WORK: / Are you contactable at work? YES / NO
EMAIL ADDRESS
ANY PREVIOUS SURNAMES
Do you have a full valid driving licence? YES / NO
How did you hear about this vacancy? (please specify)
  • Online? (Which site? eg Job Centre / Charity Jobs / Total Jobs etc)
  • Newspaper?
  • Other?

Do you need permission to work in the UK? YES / NO / Work permit expiry date:
What is your National Insurance Number?
3. EDUCATION
Secondary school attendedName and Address / Full dates
From To / Qualifications
(Level and Subjecteg GCSE Mathematics) / Grades
(eg C)
4. FURTHER AND PROFESSIONAL EDUCATION
College/University attended
Name and Address / Full Dates
From To / Qualifications
Level and Subject / Grades / Classifications
5. MEMBERSHIP OF PROFESSIONAL BODIES
Membership Body / Full Dates / Number / Qualification
6. TRAINING
Please list any relevant training you have undertaken or are undertaking, and any professional qualifications achieved. (Continue on a separate sheet if necessary)
Organiser / Course details / Dates / Title of qualification
7. PRESENT EMPLOYMENT
JOB TITLE
NAME & ADDRESS OF EMPLOYER
DATE STARTED
SALARY / WAGE
NOTICE REQUIRED
BRIEF OUTLINE OF DUTIES AND RESPONSIBILITIES
REASON FOR LEAVING
8. SUMMARY OF PREVIOUS EMPLOYMENT
Please indicate any gaps in your employment and the reasons for them
(Continue on a separate sheet if necessary)
JOB TITLE
State f/t, p/t, voluntary / EMPLOYER’S NAME & ADDRESS / FULL DATES
From To / REASON FOR LEAVING
9. ACTIVITIES AND INTERESTS
Please give details of any activities or interests you feel may be relevant. Include any qualifications or awards, and levels of achievement.
10. CRIMINAL RECORD
Have you ever been convicted of a criminal offence, including those considered spent? YES / NO
If yes, please give details:
Please note that you will have to have a CRB enhanced disclosure before employment can commence. If you have already been police checked, please give date of last check, and name of notifying authority:
Date: / Notifying authority:
11. REFERENCES
Please give below the names and addresses of two people who are willing to act as referees. One of the referees must be your present or last employer.
NAME / NAME
DESIGNATION / DESIGNATION
ADDRESS & POSTCODE / ADDRESS & POSTCODE
TELEPHONE NUMBER / TELEPHONE NUMBER
Email address / EMAIL ADDRESS
Please indicate if you do not wish us to contact your present employer until an offer has been made.
Management reserves the right to contact any former employers.
12. INFORMATION TO SUPPORT YOUR APPLICATION
Using a separate sheet, please indicate why you believe you would be suited to this position.
You should use the job description and person specification along with your knowledge and experience as guidance.
13. DECLARATION BY APPLICANT
I confirm that I have enclosed a statement supporting my application (see section 12)
I certify that the information given in this form is correct
Signed: / Date:
Please returnthe completed application form to:
by noon on 29th August 2012