Post you are applying for:
Where did you learn of this vacancy?

Contact details:

Name:
Address:
Postcode:
E-mail:
Telephone (daytime):
Telephone (evening):
Preferred method of contact (if applicable):

References:

Please give the details of two people who can provide references for you. At least one of these should be a current or most recent employer.

1. Name: / 2. Name:
Address: / Address:
Postcode: / Postcode:
E-mail: / E-mail:
Telephone (day): / Telephone (day):
Telephone (evening): / Telephone (evening):
How do you know this person? / How do you know this person?
May we contact this person before appointment? / May we contact this person before appointment?

Reasonable adjustments:

The selection process consists of this form and an interview. Do you need any adjustments to be able to participate in this process? If so, please specify:

Criminal offences and safeguarding children and vulnerable adults

The position you have applied for is exempt from the Rehabilitation of Offenders Act 1974 and may be subject to a Disclosure and Barring (CRB) check. This means that you should provide information about all previous convictions, including those that are spent. Failure to disclose relevant information below could lead to Gloucestershire Rape and Sexual Abuse Centre withdrawing an offer of employment.

The information you provide here will bekept confidential and only disclosed to those parties relevant to the recruitment process.

The disclosure of a criminal record will not necessarily prevent your employment with Gloucestershire Rape and Sexual Abuse Centre. Inmaking a decision, we will carefully consider any conviction’s relevance to the appointment.

Have you at any time been convicted of a criminal offence? Yes / No

Have you been restricted from working with children or vulnerable adults? Yes / No

If the answer to either or both of these questions is ‘yes’, please give details:

Education: Relevant to this position.
Provider / Qualifications obtained (please write in full – not abbreviations) / Dates of study

Employment: Please ensure you show all employment including an explanation for any gaps

Current / most recent employment
Employer’s name
Employer address
Position
Main Responsibilities
Key achievements:
Salary / Start date / End Date / Period of notice
Reason for seeking new position:
Employment History continued
Employer’s name: / Main responsibilities:
Position:
Dates of employment:
Salary:
Reason For leaving:
Employer’s name: / Main responsibilities:
Position:
Dates of employment:
Salary:
Reason For leaving:
Employer’s name: / Main responsibilities:
Position:
Dates of employment:
Salary:
Reason For leaving:
Employer’s name: / Main responsibilities:
Position:
Dates of employment:
Salary:
Reason For leaving:
Employer’s name: / Main responsibilities:
Position:
Dates of employment:
Salary:
Reason For leaving:
Voluntary work (please continue on a separate piece of paper if appropriate)::
Organisation name and address / Role and responsibilities / Period
Training relevant to this position (please continue on a separate piece of paper if appropriate):
Provider / Qualifications obtained / Dates of study

Information in support of your application:

Please use this section to provide us with specific information demonstrating how you meet the person specification for this position, including examples. Aspects of the person specification required to be demonstrated in the application are indicated in the Job Description. You may continue on additional sheets if required but please ensure your answer to this question is no longer than three A4 sides in total, in font no smaller than Arial pt. 11. The information you give here will be used in the short-listing process.

Finally please explain why you are interested in this post:

Declaration

I declare to the best of my knowledge the information on this application is true. I understand that if the information I have supplied is false or misleading in any way, I will automatically be disqualified from appointment or dismissed without notice.

Signed: / Date:

Data Protection Act:

Under the terms of the Data Protection Act the information provided on this form will be held in confidence and used for the purpose of recruitment and selection and personnel administration / monitoring and no other purpose.

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