AFRUCA – AFRICANS UNITE AGAINST CHILD ABUSE

Registered Charity 1093027
Head Office:Unit 3D/F Leroy House, 436 Essex Road London N1 3QP
Head Office Tel: 0207 7042261
AFRUCA Centre for Children and Families:Phoenix Mill,20 Piercy Street,Ancoats,ManchesterM4 7HY
Email:
Website:

CONFIDENTIAL

EMPLOYMENT APPLICATION FORM

Please, type or complete in black ink

Title of the Post for Which You Are Applying: Psycotherapist (Children, Adolescent Families)

Please return the completed application form by5pm,13 October 2017

Where did you see the Post advertised? ......

Title and Surname/Family Name / Fore Names/Given Names
Do you require a work permit?
Yes/No
National Insurance Number:
(For employment in the UK; if you do not have a national insurance number and are called for interview, you will be asked to produce evidence of your eligibility to work in the UK in order to comply with the Asylum and Immigration Act 1996.)
Address:
Postcode:
Telephone numbers: Day: Evening:
Email:
Guaranteed Interview scheme (applicants with disability)
AFRUCA operates a Guaranteed Interview scheme for disabled applicants who meet the minimum criteria for the role. The charity is committed to ensuring that candidates with disabilities are able to compete on equal terms with other applicants during the selection process. As part of this commitment we willinterview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities.
Who is eligible?
To be considered eligible for Guaranteed Interview scheme you must be considered as disabled under the Disability Discrimination Act (1995). This means you must have or have had in the past, a ‘physical or mental impairment’ which has had a substantial adverse impact on your normal day to day activities. This includes sensory impairments, people who have had a disability in the past even though they are no longer disabled, people whose disability is likely to last for 12 months or rest of their life, and people whose condition is likely to progress or recur. Severe facial disfigurement is also acknowledged as a form of disability.Information will be held at strictest confidence and only accessible to AFRUCA staff dealing with specific vacancies.
If you wish to apply for a Guaranteed Interview scheme please indicate below:
Yes/No
State of Health & Assistance for Interview:
a.)Are you aware of any condition which might affect the way in which you carry out the duties of this post?
Yes/No
b.)To ensure that we do not create any such barriers in our recruitment process & help us implement our Equal Opportunities & Diversity policy more effectively please let us know if you would like us to provide any (reasonable adjustments) assistance for your interview/selection tests. (e.g. induction loop/ specialist software/wheelchair access to the building/assistance).

Employment History

Current or most recent employment
Employer:
Job title:
Dates: From: To:
Present Salary:
Notice Period:
Summary of Key Responsibilities:

Previous employment(Starting with most recent)

Dates (Month, Year) / Employer and Address / Job Title (with brief explanation of duties

Education (Since Age 16)

Please provide details of your academic qualifications
Educational EstablishmentQualification/gradeDate

Please provide details of your Professional and Vocational Training

CoursesQualification/gradeDate

Other Skills

(Please outline any additional skills you feel may be relevant to this post including any recent voluntary work)

Statement in Support of Your Application

Please give your reasons for wanting to join AFRUCA and explain why you are applying for this post. In doing so, please read the person specification and demonstrate with bullet points/headings how you meet each requirement by giving details of your experience, skills and knowledge including main achievements and adding any other relevant information in support of your application. Additional sheets may be attached. When addressing key areas in response to the role you are applying for please provide as much evidence as you can, to explain the Situation in which you acted, what you were Tasked to do, the Actions you took and the Results you achieved (STAR). Answering the questions in this way will help the short-listing panel recognise and understand the combination of knowledge, skills and competencies that you bring to the role.

Disclosure of information

Do you have a criminal record Yes No
If yes,please give details on a separate sheet in a sealed envelope. Write Your Initials on each page.

References

References will be taken up once a job offer has been made and verbally accepted. Please give TWO independent referees (one should be your current or most recent employer).

Name
Title and Organisation
Address
Capacity in which known
Telephone
Fax or email
Name
Title and Organisation (if applicable)
Address
Capacity in which known
Telephone
Fax or email

8.Declaration

I confirm that the details I have provided are correct to the best of my knowledge.

Signed………………………………………………Date……………………

RETURN COMPLETED APPLICATION FORMS& ATTACHED EQUALITY MONITORING FORMTO:
AFRUCA – AFRICANS UNITE AGAINST CHILD ABUSE
Head Office:Unit 3D/F Leroy House, 436 Essex Road, London N1 3QP. Or email:
By 5pm 13th October 2017
FOR OFFICE USE ONLY
Received By:
Date Received:

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CONFIDENTIAL – AFRUCA APPLICATION FORM