CONFIDENTIAL APPLICATION

Please return to Zara O’Brien –Homecare Manager, AGE Concern Eastbourne, The William & Patricia Venton Centre, Junction Road, Eastbourne, BN21 3QY

Personal Details:

Full name: / Title:
Address: / Date of birth:
Telephone (Home)
Telephone (Work)
May we contact you at work? Yes/No
Email Address:

Education & Training

Please give details of your education and training including any academic or vocational qualifications achieved. You may also include any relevant
non- examined courses such as evening classes.
Date / Institution / Subjects / Qualification

Work Experience

Name of present or last employer:
Address:
Start date: / Leaving Date:
Position held:
Responsibilities:
Final Salary: / Notice Required:
Reasons for leaving:

Other Work

Please give details of all other employment starting with the most recent. Please include part-time and unpaid work.
Employer / Position and Duties / From / To

Why do you think you are suitable for this position?

Please state how your experience and skills, gained both inside and outside paid work, or through study and training, meet the requirements for the post as outlined in the person specification.

Health

Is there anything in your medical history, such as serious illness, disability or surgery, which may affect your ability to do this job? If so, is there anything we could provide to assist you?
Please give details.

Further Information

Is there anything else relevant to your application not covered elsewhere on the form?

Hours

We will consider full-time/job share or part-time hours. Please tell us your preferred hours and availability if part-time hours preferred.

Are you available to attend for interview on the date shown? Yes/No

Our policy is to request references from everyone who works with us. Please give details of two referees, indicating in what capacity you know them. One should be your present or most recent employer. Please tick here if you do not wish for us to contact referees prior to interview.

Name:
Address:
Telephone Number:
Email:
In what capacity do you know the referee? / Name:
Address:
Telephone Number:
Email:
In what capacity do you know the referee?

Declaration:

I declare that the information on this form is true and correct to the best of my knowledge.

Signature of applicant: Date:

EMPLOYMENT OF EX-OFFENDERS AND REHABILITATION

OF OFFENDERS ACT

Age Concern Eastbourne is of the opinion that the above post is exempt from the Rehabilitation of Offenders Act and that applicants are required to declare any relevant past criminal convictions. Age Concern Eastbourne recognises that is has a duty to vulnerable elderly people to take account of offences that may have a direct bearing on a candidate’s suitability for this post.

Age Concern Eastbourne only requires of candidates details of spent convictions that fall within the following categories:

1. Offences of a sexual nature;

2. Offences involving minors under the age of 18;

3. Drug trafficking;

4. Theft, burglary, fraud or similar offences which occurred within the previous five years and where the conviction is not yet spent under the terms of the Rehabilitation of Offenders Act:

5. Offences, which involved the use or threat of violence.

All information supplied by candidates is treated in the strictest of confidence. Where a short listed candidate has a conviction which falls within one of the above categories we reserve the right to make further enquiries before reaching a decision on her or his application.

All candidates will be entitled to expect confidentiality for information supplied at the time of the application about past convictions and Age Concern Eastbourne Management will treat any unauthorised disclosure of this information of related discrimination as a very serious matter.

Please answer the following question:

Have you ever been convicted of a criminal offence?YES/NO

Signed……………………………………………….

Dated…………………………………………………

If you have been convicted of a criminal offence, please enclose details in a sealed stamped-addressed envelope. This will be returned to you unopened in the event that you are not short-listed for the post.