Application No: CCGOA/

POST TITLE: Community Engagement Officer / Administrator

CLOSING DATE: Noon, Friday 13 February 2015

  1. We encourage you to save this form as a word document and complete the details electronically. Alternatively you may complete the form in black ink or typescript
  1. Please e-mail your completed form to . Alternatively please post or hand deliver your application to Charlotte Bates, Durham Community Action Limited, 8 St Stephen’s Court, Low Willington, Crook, Co. Durham DL15 0BF. Please clearly mark your envelope ‘Community Engagement Officer / Administrator Application’.
  1. We regret that we are unable to acknowledge receipt of application forms (whether submitted electronically, by post or in person). If you have not heard from us by 23 February 2015, please assume that your application has been unsuccessful.
  1. Only applications on this standard form, received by the closing date above will be accepted.
  1. Any additional information to support your application may be attached electronically. If you are submitting as a hard copy, please ensure that it is completed in black ink or typescript. Supporting documents should not duplicate information that has been given on the Application Form. Please do not include a CV as an alternative method of application.

Durham Community Action aims to be an Equal Opportunities Employer. It is our policy to ensure that all applicants receive equal consideration, and are appointed on their merits.

This Application Form has been designed to help fulfil these aims by serving two purposes. Firstly, the top sheet covering Sections 1 to 11 will be removed by the Recruitment Officer and the information used for equal opportunities monitoring. This will help Durham Community Action check the effectiveness of its Policy. Secondly, the remainder of this application form covering sections 12 to 21 will be used to select for interview.

The selection panel will not see the detachable front sheet when they are selecting for interview. This sheet will be separated on receipt of your application, and will be treated in strict confidence. The interview panel will be given a copy of the detachable sheet after shortlisting has taken place.

DECLARATION

I declare that the information given in this application is, to the best of my knowledge, accurate in all respects. I understand that giving false information or leaving out important information will make my application unacceptable and if, I am appointed, may lead to dismissal. I confirm that I have not canvassed either directly or indirectly in connection with this application.

SIGNATURE: ______DATE: ______

(If you complete this form electronically, and are successful in being shortlisted for interview, you will be asked to sign this declaration on a printed copy at the time of your interview).

1. TITLE
2. SURNAME
3. FORENAME (S)
4. FORMER SURNAME
(where appropriate)
5. ADDRESS
(including postcode)
6. TELEPHONE / Home
Mobile
Work
7. E-MAIL ADDRESS
  1. ETHNIC ORIGIN: (Please indicate by marking appropriate box)

Black AfricanBangladeshiIrish

Black CaribbeanChinesePakistani

Black OtherIndianWhite

Other (please specify)  ______

  1. HEALTH
  • Do you consider yourself to have a disability? Yes  No 

If yes, please provide brief details

______

  • Would the provision of any aids or modification help you carry out the duties of this post?

______

  • Is there anything we need to know about your disability in order to offer you a fair selection interview e.g. do you need a signer or an accessible interview room?

______

10.ADVERTISEMENT: Where did you see this vacancy? ______

  1. RELATIVES OF MEMBERS OR EMPLOYEES?

Are you related to any Member or Senior Employee of DCA Yes  No 

If yes, please state name of relative & position held

______

(NB canvassing or failure to disclose will disqualify)

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Application No: CCGOA/

POST TITLE: Community Engagement Officer / Administrator

CLOSING DATE: Noon, Friday 13 February 2015

  1. EDUCATION AND QUALIFICATIONS

School/College/etc
/
Qualifications obtained
/
Grade
/ Date Taken
  1. PROFESSIONAL QUALIFICATIONS (including membership of professional bodies)

Name of Body/Institute
/
Level of Membership
/
Year Obtained
  1. CURRENT STUDIES/EXAMINATIONS TO BE TAKEN

Name of College etc
/
Course
/
Level
/
Examination Date
  1. TRAINING AND DEVELOPMENT

Indicate attendance at seminars, lectures, workshops or short courses whether or not leading to a recognised qualification.

Name of Course
/
Duration
/
Details
  1. PRESENT OR PREVIOUS EMPLOYER

Name of Present/Previous* Employer:
Address:
Position held: / Grade: (if any)
Salary:
Date commenced: / Date left: (if appropriate)
Notice required: (if appropriate)
Reason for leaving:
Main duties and responsibilities:

* Please delete

  1. EMPLOYMENT HISTORY

(Please list all positions held, most recent first, identifying any periods of unemployment)

Name and Address of Employer / Position held and Grade (if any) /
Date
/
Reason for Leaving
From
/
To
  1. REHABILITATION OF OFFENDERS ACT 1974 (Exemptions Order 1975)

A criminal record does not exclude an applicant from being considered for this post so long as the offence(s) is not incompatible with the post. You are required to list below details of the offence(s) and sentence imposed (including fines) which have not expired under the terms of the Rehabilitation of Offenders Act 1974. Failure to disclose at this stage will lead to instant dismissal. Spent convictions need not be declared.

Nature of offence:(s)
Date(s) of sentence:(s)
Sentence(s) received:
Any other information you wish to give:
  1. GENERAL
Do you hold a current driving licence? YesNo
Do you have a vehicle available for daily use?YesNo
  1. REFERENCES

Please give details of two persons, one of whom must be your present employer. If you are unemployed you must provide a reference from your most recent employer. If you are in, or just completed full time education, one referee should be from your school or college. Please indicate below whether we may take up references prior to interview. (If you are known to your referees by a previous name, please give details).

Name: / Name:
Occupation: / Occupation:
Address: / Address:
Telephone: / Telephone:
E-mail: / E-mail:
May we contact prior to interview:
Yes  No  / May we contact prior to interview:
Yes  No 
  1. FURTHER DETAILS

In support of your application, you are invited to give details of your experience, current responsibilities and particular achievements (gained both inside and outside employment) which you consider relevant to this application and will assist us in assessing your suitability for this post.

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