Enabling Single Homeless People to Live Independently, Through: Education, Supported

Amicus Trust

Enabling single homeless people to live independently, through: education, supported accommodation, resettlement service & support in the community

Private and Confidential

Post applied for:

Amicus Trust is an equal opportunities employer. It aims to meet both its statutory duties in relation to equal opportunities and to follow accepted good practice in this area. Amicus Trust’s policy is that no applicant or employee should receive less favourable treatment than another on grounds of sex, marital status, race, colour, nationality, ethnic origin, religious or political beliefs, age, class, sexual orientation, responsibilities for dependants, disability or unrelated criminal convictions.

Amicus Trust has been awarded the Disability Symbol by Jobcentre Plus. This means that Amicus Trust follows a set of commitments to ensure we are positive about disabled people.

In order to ensure that we are meeting our aims, and to be able to produce supporting evidence if required, we routinely collect information on ethnicity/race, gender, disability, age and sexual orientation from all existing and potential employees for monitoring purposes only. This information is held by the Human Resources department only and forms no part of any selection process, either in your initial appointment to your post at Amicus Trust or at any time in the future.

We would be grateful therefore if you would select the categories most appropriate to yourself from the questions below and return this form, in confidence, together with your application form.

What is your gender? Male □ Female □

Do you consider yourself to have a disability or learning difficulties:

Yes □ No □

This information is needed so all applicants who have a disability that meet the minimum criteria for this position will be offered an interview.

What is your sexual orientation?

Bisexual □ Gay Man/homosexual □ Gay woman/lesbian□ Heterosexual/straight □ Other □ Prefer not to say □

What age group are you in?

16 -24 years □ 25-49 years □ 50 years and over □

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Amicus Trust Application and Equal Opps Form –December 2014 – Version 2

Confidential: Amicus Trust / For Office use:
Eq Opps No.
Position applied for:
Instructions: Please write clearly using a Black Pen only. For Yes or No choices – please strike out the answer that does not apply and/or circle the one that does apply.
Personal Details: We ask for personal details on Page 1 only. This is removed before the interview panel decide which candidates will be offered an interview. Therefore, please take care not to have your name anywhere after page 1. A covering letter is welcome when you send in the application form but it is not necessary and will not be used in selecting candidates for interview.
Title (Mr, Ms, Mrs, Miss etc)
First Name:
Middle Name/s (if any)
Last Name:
Name you wish to be known by:
Address:
Post code:
E-mail Address:
Telephone-Home:
Telephone-Mobile:
Telephone-Work:
May we contact you at work? / Yes □ No □
National Insurance No:
Date of Birth:
Health and General Attendance / Please give details of the number of days and incidents you have been absent from work in the past two years.
Days 5 incidents 5
Do you have a current Driving Licence valid in the UK? / Yes □ No □
Are you eligible to work in the UK? (If no, please give details on a separate sheet) / Yes □ No □

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Amicus Trust Application and Equal Opps Form –December 2014 – Version 2

Confidential: Amicus Trust– / Eq Opps No.
Position applied for:
History of Education & Training: Place in order with most recent or current first. Indicate if part time & if so on what basis (e.g. 1 day per week). Only use separate sheet if absolutely necessary.
Name & Address / Date From & To: / Qualifications Obtained

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Amicus Trust Application and Equal Opps Form –December 2014 – Version 2

Confidential: Amicus Trust- / Eq Opps No.
History of Employment: Place in order with most recent or current first. Indicate if part time & if so on what basis (e.g. 1 day per week). Only use separate sheet if absolutely necessary.
Present/most recent employment:
Employers name, address, post code:
Job Title:
Contact Telephone No: / Date started in Post:
Date Left if no longer employed:
Salary:
Reason for leaving:
Briefly describe your main duties and responsibilities in the above role:
Name, Address, Type of business / Date From & To: / Job Title, Duties or Responsibilities / Salary / Reason for change

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Amicus Trust Application and Equal Opps Form –December 2014 – Version 2

Confidential: Amicus Trust- / Eq Opps No:
After reading the job description and person specification, please say why you are applying for the post and tell us how you meet the requirements of the job. Highlight any knowledge, experience and skills that you consider relevant to the post you are applying for. Please continue on no more than two sheets of A4 paper.

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Amicus Trust Application and Equal Opps Form –December 2014 – Version 2

Confidential: Amicus Trust- / Eq Opps No.
Criminal Convictions – Please note that all posts are subject to an enhanced Disclosure and Barring Service check for vulnerable adults if successful at interview.
Do you have any criminal convictions? Yes 5 No 5
If Yes Please give details on a separate sheet, this should exclude any spent convictions under Section 4 (2) of the Rehabilitation of Offenders Act 1974, unless the job for which you are applying involves working with vulnerable adults or children in which case cautions, bindovers, pending prosecutions, spent and unspent convictions must be declared.
References: Please give details of your present or most recent employer and one responsible person to whom you are well known but to whom you are not related, and to whom we may write for a reference concerning your suitability for this post.
Name & Address of Referee / Their position/
occupation / How long have they known you / May we contact them
(1) Present Employer
(2) Previous Employer
Notice Period?
Declaration:
In accordance with the Data Protection Act 1998, the information provided on this form will be used in the recruitment and selection process and may be disclosed to all those who need to see it. It will also form the basis of the confidential personnel record of the successful candidate. In the case of unsuccessful candidates, this application form will be destroyed after twelve months.
I declare that to the best of my knowledge the information I have given in this application form is true. I acknowledge that if it is found that I have knowingly provided false information, this will lead to the withdrawal of a job offer or termination of my employment.
Signature
Date
After completion please return this form marked ‘Private and Confidential’ Cath Crook, Human Resources, Amicus Trust Limited , 31A Prebend Street, Bedford, MK40 1QN
Amicus Trust is a charity registered in England and Wales under number 268639 and a company limited by guarantee in England and Wales under number 1182060. Our registered office is 31A Prebend Street, Bedford, MK40 1QN

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Amicus Trust Application and Equal Opps Form –December 2014 – Version 2