Vacancy Applied for: Night Concierge – Elizabeth Street Project

Full Name / Mr/Mrs/Miss/Ms
Address for correspondence:
Post Code:
Tel No. / Mobile: / Home: / Work:
Email: / National Insurance No.

Are you applying for this position on a job share basis?YESNO
Calico is committed to employing a workforce that is inclusive and diverse by removing any barriers and tackling discrimination.
If you are a disabled person and you fulfil all the essential criteria on the enclosed person specification to the satisfaction of the selection panel, you are guaranteed an interview. If you wish to be included in this scheme, please indicate in the box below.

I am disabled and would like to take part in this scheme ( please tick)
Adjustments For Selection Purposes
Please contact us if you need the application form in an alternative format or of you need any adjustments for the interview.
Please note that this information does not form part of the selection process.
Do you have any relationship with a Board Member, member of staff, resident, tenant or client of the Calico Group? Yes/No
If yes, please state their name and the nature of your relationship:
Name: ______Nature of relationship: ______
Signed: ______Dated: ______
I declare that the information provided in my application is correct and understand that if appointed, I will be liable to disciplinary action including dismissal should I knowingly give false information.
Signed: Dated: ______
The information given above may be processed and used for recruitment, selection, statistics and monitoring purposes. If you join the Company, the information will form the basis of your personal file. The data will then be processed for any purpose in connection with your employment relationship; training and development; remuneration; or the effective management of the organisation.
Signed: ______Dated: ______

Calico is committed to providing equal opportunities for everyone, regardless of ethnic origin, gender, disability, age, transgender, religion or sexual orientation and in accordance with the 9 protected characteristics of the Equality Act 2010. We therefore ask you to provide us with the information requested on this form. Please be assured that this information is used for monitoring purposes only in order to comply with current employment legislation and to promote equality of opportunity throughout the company. By monitoring this information for job applicants we are able to identify and remove any barriers that may exist for any groups or individuals. This form will be kept separately from your application form and has no part in the selection process

1. Vacancy applied for:Night Concierge – Elizabeth Street Project
2. Ethnic origin: (*To which group would you say you belong? Please tick one box.)

*These categories are approved by the Equality and Human Rights Commission
3. Gender


If you are permanently living in the gender not of your birth please tick
4. Disability
ARE YOU DISABLEDNO YES (please refer to Personal Information Form)
  1. Age – Please tick the category to which you belong

UNDER 2525-3435-5455-64>64

6. Religion/Faith (Please tick the category to which you belong)


Sikh Other Prefer not to say
7. Sexual Orientation (Please tick the category to which you belong)

Heterosexual LesbianGayBi-SexualPrefer Not to Say

8. Where did you INITIALLY see the advert – please tick appropriate box.


OTHER WEBSITE (which site) ______
PRESS ADVERTISEMENT (which publication) ______
Application For Employment /
Vacancy Applied for: Night Concierge – Elizabeth Street Project
Present or most recent employment
Job Title / Date of Employment
Employer / Notice Required
Reason for leaving
(if applicable) / Salary
Brief description of duties
Previous Employment / Please give details of past work you have undertaken. This can include paid work, unpaid or voluntary work, self employment or work at home.
Job / Employer / From / To / Reason for Leaving
Gaps In Employment / Please provide a brief explanation below of any gaps in your employment history



Qualifications and/or examinations passed Grade





Special Training / (include any relevant short courses and development activities you have undertaken)

DetailsDuration of course/activity





Driving Licence

Do you hold a current full driving licence?Yes / No

Please provide details of how you are suitable for the position and meet the person specification. Please include qualifications, experience, skills, knowledge and any other information which you feel may be helpful to your application (continue on a separate sheet if necessary). CV’s will not be accepted.


Please return this form to: Human Resources, Calico, Centenary Court, Croft Street, Burnley, BB11 2ED



Please give details of your referees. These should include all employment references covering the last three years, including your present or most recent employer. In all cases a minimum of two referees must be provided.
If you are applying for a role involving client care you must provide details of your last CQC registered / care employer regardless of when you left.
If your first referee covers the last three years of your employment, you will still need to provide a second referee. This should be a person who has knowledge of your skills and would be able to comment on your ability to do the job you are applying for, for example: a Club or Charity for whom you work voluntarily; or School or College
If you have been self-employed for the last three years, or have never been employed, you should still provide the names of two people who can comment on your suitability for this post.


Name: / Name:
Address: / Address:
Telephone No: / Telephone No:
Fax No: / Fax No:
E mail: / E mail
Relationship: / Relationship:
Dates Employed / From: / To: / Dates Employed / From: / To:
Name: / Name:
Address: / Address:
Telephone No: / Telephone No:
Fax No: / Fax No:
E mail: / E mail
Relationship: / Relationship:
Dates Employed / From: / To: / Dates Employed / From: / To:
Please note, it is the requirement of the Company’s Insurance Policy that satisfactory written references are obtained direct from former employers covering the previous 3 years. Therefore, an offer of employment will be subject to the receipt of satisfactory references

The disclosure of a criminal record will not debar your appointment unless the selection panel considers that the conviction renders you unsuitable for appointment. In making this decision the panel will consider the nature of the offence(s), how long ago and what age you were and any other factors which may be relevant.

Failure to declare a conviction may, however, disqualify you from an appointment, or result in the termination of your contract if the discrepancy comes to light.


On this form you must disclose any conviction you have received, including convictions as a juvenile, which have not become ‘spent’.

You must also disclose details if you are currently the subject of a police investigation/police proceedings which could result in a conviction, caution or bind over order.

Unspent Criminal Convictions
Do you have any UNSPENT convictions, cautions or bind over orders ? / Yes: No:
Details (Continue on a separate sheet if necessary)
Date / Court / Offence / Penalty

I understand that failure to disclose fully any unspent criminal conviction, caution or bind over order may lead to any job offer being withdrawn, or to disciplinary action up to and including dismissal.


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