Gmcna Applicationform

GMCNA APPLICATIONFORM

StrictlyConfidential

POSITIONAPPLIEDFOR

(Coach/Assistant

SatelliteorCounty)

A CurriculumVitae mayaccompany this formbut cannotreplace it.

Please complete all parts clearlyand return to

Sam Longley GMCNA Chair,

259 Birch Lane, Dukinfield, Cheshire, SK16 5AU

PARTA– PERSONALDETAILS
SurnameForenames
Home Address
PostcodeContact Email Address
Mobile phone number Home phone number
PARTB–RELEVANTQUALIFICATIONS/AWARDS-List detailsof relevantqualification/awardsto theroleapplied for
Date Qualified / QualificationObtained / Awardingbody
PARTC–CONTINUEDPROFESSIONAL DEVELOPMENT–ListdetailsofanyrelevantCPDcourses/workshopsetc.thatyou
have attended in the last4years
Date / Course/workshop

PARTD–FURTHERINFORMATION

In support ofyour application please provide the followingadditional information:

1.Yourcoachingexperienceandcurrentcoachingroles

2.Outlineyourreasonsforapplyingforthisrole

3.Detailyourachievementswithincoaching

PARTE- VERIFICATIONOF EMPLOYMENT ANDREFERENCES
Please give the names, addresses and status oftwocharacter referees.These should not be relations.
NameName
Job titleJob title
CompanyCompany
AddressAddress
Telephone numberTelephonenumber
PARTH– HEALTH
Applications from all candidates arewelcomed and the associationwill make every effort to ensure a fairselection process.Areyou in good health? Yes/ No
Please givedetails of any health / disability issueswhich may be relevant to this position.
PARTI-LEGALPROCEEDINGS
Have you anyprevious convictions for a criminaloffence or are any legalproceedings pending?Yes/ No If Yes please give details onaseparate sheet
Please note that failure to disclose any criminal convictionwill disqualify a candidate fromthe appointment and, if appointed,may render theindividual liable to immediate dismissal without notice.
DECLARATION
Ideclaretothebestofmyknowledgeandbelief,allparticularsIhavegivenarecompleteandtrue.Iunderstandthatanyfalse declarationormisleadingstatementorasignificantomissionmaydisqualifymefromemploymentandrendermeliabletodismissal.Iunderstandthatanyjobofferissubjecttoreferences,aprobationaryperiodand,iftheorganisationbelievesitappropriate,a medical report, all ofwhich must be deemed satisfactory.
Signed: Print name:
Date: