Job Application Form

Confidential

Application for post of: Community Organiser

  1. Personal Details

Last name:
First name:
Title (if any)
Address:
Postcode
Email
Telephone numbers:
(daytime? evening?)
National Insurance number:

Recent relevant paid or voluntary work experience

Please tell us about the paid jobs and voluntary work you have done, starting with the most recent first. You should include your current jobs.

Employer
(if self-employed or volunteering please explain) / Role / Main duties
(up to 5) / Dates
from and to

Training and qualifications

Please tell us what training and qualifications you have completed.

If you have a lot, please tell us the ones most relevant to the post.

Title of course / Training provider / Qualification, level & result
(if relevant) / Main subjects covered / Dates
to and from

Personal Statement

In support of your application please explain why you are applying for this position showing what contribution you can make to the Community Organisers programme.

Clearly show how you meet the essential and preferred criteria for Trainee Community Organiser as listed in the person specification.

Include evidence and actual examples of how your knowledge, experience, skills and personal qualities relate to the criteria. Remember that you will have abilities, experience and skills from many aspects of your life; some may come from education or work, others from home or community life.

Please continue on a separate sheet of paper if you need to.

Make sure you attach it securely to this one.
Convictions

If you have an unspent criminal conviction you must always declare it. Having a criminal record will not necessarily preclude you from working. This will depend on the circumstances and background of your offence.

Do you have an unspent conviction of a criminal offence under the Rehabilitation of Offenders Act 1974?

Yes No
If Yes then please give brief details:

How did you find out about the Community Organiser post?

Relationship to a Member or Employee of Burslem School of Art Trust or Staffordshire University

Are you related to a Member or Employee of Burslem School of Art Trust or Staffordshire University?

Yes No
If Yes then please give brief details:

Disability

We want to make sure that we can make reasonable adjustments to enable you to take part in the recruitment process for this post.

Disability is defined by the Equality Act 2010 as 'a physical or mental impairment which has a substantial and long-termadverse effect on their ability to perform normal day-to-day activities'.

-'substantial' means more than minor or trivial

-'long-term' means that the effect of the impairment has lasted or is likely to last for at least twelve months

-'normal day to day activities' includes everyday things like eating, washing, walking and going shopping

Please indicate below if you consider yourself to have a disability. If yes, pleaseindicatethe type of disability from the list. Tick all that apply.

Specific learning disability
General learning disability
Cognitive impairment
Long term illness or health condition
Mental health condition
Physical impairment or mobility issue.
Deaf or serious hearing impairment
Blind or serious visual impairment
Other type of disability

Do you require any assistance to enable you to participate in an interview or to carry out this post?

Yes No

Please use the space below to provide us with any further information:

References

Please give details of two referees. One should be your current or last employer. Referees will not be approached until a job offer is made.

First Referee / Second Referee
Name / Name
Job title / Job title
Relationship to you / Relationship to you
Address / Address
Email / Email
Telephone number / Telephone number

NB: If either of your referees know you by a name other than your present one, please give that name below:

Declaration

I declare that the information provided in this application is correct to the best of my knowledge.
Signed: …………………………………………..
Date: ………………………

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