Vision ref
Job ref
Job title
Closing date
Interview date
Personal information
Surname / Click here to enter text. / Mr/Mrs/Ms/Other / Click here to enter text. /First Name / Click here to enter text. / Previous Names / Click here to enter text. /
Prefers to be known as / Click here to enter text. /
Home Address / Click here to enter text. / Home tel / Click here to enter text. /
Mobile tel / Click here to enter text. /
Email / Click here to enter text. /
Employment History and References
Starting with the most recent first, tell us about who you have worked for and details about the jobs that you have held. Include full-time, part-time and any unpaid work. You should explain the reasons for any breaks in employment dates (e.g. unemployment, raising a family etc.)
Please note that we request references from all your employers for the past three years after an offer of employment has been made. Please continue on a separate sheet if necessary.
Details of employer / Job title and main duties / Reason for leaving and duration of employmentName / Click here to enter text. / Click here to enter text. / Reason for leaving / Click here to enter text. /
Address / Click here to enter text. /
Tel / Click here to enter text. / Dates
Email / Click here to enter text. / From: Date / To: Date
Name / Click here to enter text. / Click here to enter text. / Reason for leaving / Click here to enter text. /
Address / Click here to enter text. /
Tel / Click here to enter text. / Dates
Email / Click here to enter text. / From: Date / To: Date
Name / Click here to enter text. / Click here to enter text. / Reason for leaving / Click here to enter text. /
Address / Click here to enter text. /
Tel / Click here to enter text. / Dates
Email / Click here to enter text. / From: Date / To: Date
Name / Click here to enter text. / Click here to enter text. / Reason for leaving / Click here to enter text. /
Address / Click here to enter text. /
Tel / Click here to enter text. / Dates
Email / Click here to enter text. / From: Date / To: Date
Name / Click here to enter text. / Click here to enter text. / Reason for leaving / Click here to enter text. /
Address / Click here to enter text. /
Tel / Click here to enter text. / Dates
Email / Click here to enter text. / From: Date / To: Date
General and further education
Current studies
If you are studying either on a part-time or full-time basis, please complete the details below.
Please note that we may request a reference from your place of study.
Name of course / Click here to enter text. /College/University / Click here to enter text. /
College/University address / Tel / Click here to enter text. /
Click here to enter text. / Postcode / Click here to enter text.
Tutor’s name / Click here to enter text. /
Please give details of educational and professional qualifications
Subject / Qualification / Grade / Date ObtainedClick here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Please indicate membership of any organisation(s) relevant to the job
Name of organisation / Type of membership / Is membership current?Click here to enter text. / Click here to enter text. / Click here to enter text. /
Additional information
We asked the people we support what’s important to them; please look at each statement on the following pages and explain how you would support them. You can use examples from your life experience to answer the questions. This could be from previous employment, family, friends or social situations.
“It is important to me that I am supported how and when I like to be. How would you do this?"
Click here to enter text.
“I want my team to work together to support me. How would you ensure this happens?”
Click here to enter text.
“How would you support me to try something for the first time?”
Click here to enter text.
“Punctuality and reliability is extremely important to me, how do you feel about that?”
Click here to enter text.
other information
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013)
The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.
- Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?
Any offer of employment with Avenues may be subject to an Enhanced Disclosure from the Disclosure and Barring Service (DBS) including the DBS Adult Barred List and DBS Children’s Barred List. Any previous conviction does not preclude you from employment – we would discuss the relevance with you.
- Do you require a permit to work in the UK?
If yes, please go to question 3. If no, then please go to question 4. If yes, you will be required to produce the original document.
- Is this a student visa?
- Are you related to an existing member of our staff?
- Do you have a full UK driving licence?
- Do you have a vehicle you can use for business purposes?
I confirm that the information I have given is true and complete. I understand that any false or misleading information will result in rejection of my application of dismissal from employment.
Signature / Click here to enter text. /Date / Click here to enter a date. /
Where did you see this position advertised? / Click here to enter text. /
If an existing member of staff advised you of this post, please enter their name: / Click here to enter text. /
Avenues Locations
Name / Click here to enter text. /Date / Click here to enter a date. /
Avenues works across the South East of England and the West Midlands.
Please tell us of any specific areas that you would be interested in working in using the boxes below.
It is not necessary to complete this section for office based roles.
London Boroughs / Click here to enter text. /Surrey / Click here to enter text. /
Kent / Click here to enter text. /
East Anglia/Cambridgeshire / Click here to enter text. /
Shropshire / Click here to enter text. /
Equality Monitoring
We aim to attract and recruit potential employees who have the relevant skills, qualifications and experience to make a positive contribution to the work of Avenues. We pride ourselves as an equal opportunities and fair treatment employer. We oppose unlawful and unfair discrimination on the grounds of sex, age, race, religion or belief, marriage or civil partnership status, sexual orientation, gender reassignment, disability, pregnancy or maternity or any other irrelevant factor.
We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates. We select all candidates for interview based on their skills, qualifications and experience.
Please complete this section of the form to help us monitor the effectiveness of our work in this area. This information will be treated as confidential and will not form part of the selection process.
Male / FemaleDate of Birth / Click here to enter a date. / Age / Click here to enter text. /
What is your ethnic group?
Choose ONE selection from A to E, then tick the appropriate box to indicate your cultural background.
A) WhiteB) Mixed
English/Welsh/Scottish/Northern Irish/BritishWhite and Black Caribbean
Irish White and Black African
Gypsy/Irish Traveller White and Asian
Other, please specifyOther, please specify
Click here to enter text. Click here to enter text.
C) Asian/Asian BritishD) Black/African/Caribbean/Black British
IndianCaribbean
Pakistani African
BangladeshiOther, please specify
Chinese Click here to enter text.
Other, please specify
Click here to enter text.
E) Other ethnic group
Arab
Other, please specify
Click here to enter text.
The Avenues Group are positive about employing disabled people and we operate the Guaranteed Interview Scheme (GIS) which guarantees an interview to any disabled applicant who meets the minimum criteria required for the role.
The Equality Act 2010 defines a person as having a disability if they have a physical or mental impairment and the impairment has a substantial and long term adverse effect on their ability to perform normal day-to-day activities.
Do you consider yourself to be disabled within the definition (please see above)? Yes No
Please choose one option that best describes your sexual orientation.
Gay/Lesbian
Heterosexual/Straight
Bisexual
Other (Please Specify)Click here to enter text.
Would rather not answer
What is your marital status?
Please choose one option that best describes your marital status.
Single
Married
Separated but still legally married/in same sex civil partnership
Divorced
Widowed/Surviving partner of same sex civil partnership
In a registered same sex civil partnership
Formerly in a same sex civil partnership which is now dissolved
Other (Please Specify) Click here to enter text.
Would rather not answer
What is your religion?
Please choose one option that best describes your religion/belief.
No religion
Sikh
Jewish
Muslim
Hindu
Buddhist
Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
Other (Please Specify)
Would rather not answer
Name / Click here to enter text. /
Date / Click here to enter a date. /
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