Community Access Support Services Limited

CASS

Community Access Support Services Limited

PERSONAL ASSISTANT – Community Support

Application Form

Surname: Title (Mr/Mrs/Ms/Miss/etc):

Forenames:

Address:

Home Tel. No:Mobile Tel. No:

E-Mail Address:

N.I. No:

Relevant Qualifications/Education:

Please describe your current role:

From your previous employment or experience, please provide details of what you think would help you to be successful in this role:

What qualities do you think are important when working as a Personal Assistant?

Employment History

(Previous 5 years)

Details of present/most recent Employer:

Employer:

Address:

Tel. No:

E-Mail Address:

Job Title:From:To:

Address:

Brief description of your duties and responsibilities:

Previous Employer:

Employer:

Address:

Tel. No:

E-Mail Address:

Job Title:From:To:

Address:

Brief description of your duties and responsibilities:

Previous Employer:

Employer:

Address:

Tel. No:

E-Mail Address:

Job Title:From:To:

Address:

Brief description of your duties and responsibilities:

(Please provide details of any further Employers on a separate sheet of paper)

Do you drive and do own you own car?

Is your car insured for business use: Yes/No?

(If No, please note this is a requirement of employment)

What days/nights are you able to work or prefer to work?

Do you smoke?Are you prepared to undertake training?

Do you have a current DBS check? If so, please supply the details below:

Certificate No:Issued by:Date of issue:

Within the nature of work for which you are applying, this position is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of this Act. In the event of employment, any failure to disclose such convictions could result in dismissal. Information given is confidential and will only be considered for the purposes of this application and to request a DBS (Disclosure and Barring Service) check. If there is any such information you should supply it below.

Do you have any past or present convictions for criminal offences? If so, please provide full details:

Please provide below details for two references

(Preferably one from your current/most recent Employer and one personal)

Name:

Address:

E-Mail:

Tel. No:

Capacity in which known to you:

Name:

Address:

E-Mail:

Tel. No:

Capacity in which known to you:

Declaration

The details about me on this application form are to the best of my knowledge true and accurate.

Signed:Dated:

Where did you see this job advertised?
Please return your completed application form by email to:

Thank you for your application.

Community Access Support Services Limited

Registered in England – Company Number: 09725354