Employment Application Form

General notes and guidance

Please complete in black ink or type. We cannot consider any applications where this form has not been fully completed. Curriculum Vitae’s will not be considered and will be discarded.

When completing your application form please ensure that you have read both the

Job Description and the Person Specification.

It may be useful to make a copy of your application prior to sending it to us. You may need to refer back to it.

This front sheet and the monitoring form will be removed from the rest of your application form when we shortlist to ensure all candidates are treated equally.

Post applied for : Young Carers Activities Co-ordinator (37 hrs)

This form must be returned before 4pm on Monday 26th February 2018!

  1. Personal details

Full Name
Address
Postcode
E.mail Address
Telephone Number: / Day
Evening

St Helens Young Carers Centre, Fishwick House, Cotham Street, St Helens, WA10 1SJ

Telephone 01744 67 72 79

Email: Web

St Helens Carers Centre is a registered charity in England and Wales (No. 1089663) Registered as a company limited by guarantee in England & Wales No. 4203210 Registered office: 31-35 Baldwin Street, St Helens, WA10 2RS.

2. Current Employment

(Please provide details of your current employment, current salary & reason for leaving)

Employers name & address / Job title and brief description of duties
Dates of employment
Current Salary/Salary on Leaving:
£
Reason For Leaving:

Notice required by present employer :

3. Previous Employment

(Please provide details of your previous employment. Please start with your most recent)

Employers name & address / Dates of employment / Job title and brief description of duties / Reason For Leaving

4. Qualifications

(Please list qualifications relevant to this post and schools/ colleges attended)

Schools/Colleges attended / Dates / Qualifications gained

5. Training

(Please list any training courses attended relevant to this post e.g. work based training or in house training etc.)

Establishment / Dates / Course/Training attended

6. Person Specification / Experience relevant to this post

Please state how you meet each point of the PERSON SPECIFICATION listed below. The space will expand as you type:

1. Knowledge & Qualifications - Essential

2. Knowledge & Qualifications - Desirable

3. Skills & Abilities - Essential

4. Experience - Essential

5. Experience – Desirable

7. Please use this space for any other information to support your application.

8. Referees

Please provide two names and addresses of referees (one must be of your current or most recent employer). Please indicate if your references may be contacted prior to interview.

Name / Name
Position / Position
Organisation / Organisation
Address / Address
Postcode / Postcode
Telephone no.
E.mail Address. / Telephone no.
E.mail Address.
Contact prior to interview Yes/No / Contact prior to interview Yes/No

9. Rehabilitation of Offenders Act

(Please read Guidance notes before completion)

Do you have a criminal recordYes / No

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police?
(note the post you have applied for is excepted from the Rehabilitation of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed.)
If Yes, please give details of offences, penalties and dates.
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?
If Yes, please give details. / Yes / No
Yes / No

10. Declaration

I confirm that the information given in this application form is correct and complete, and that misleading statements may be sufficient for cancelling any agreements made.

I understand that, in the event of being short listed for interview I will be required to complete a declaration that will include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on my suitability for the post. I understand too that an Enhanced disclosure will be sought in the event of a successful application.

PRINT NAME

SIGNEDDATE

Equal Opportunities Monitoring Form

St Helens Carers Centre is committed to Equal Opportunities and recognises that everyone has a right to equal treatment. The Carers Centre welcomes applications regardless of race, colour, nationality, ethnic or national origin, gender, sexuality, marital status, caring responsibilities, age, physical, sensory or mental disability, mental ill-health, political belief, religion, class, employment status or un-related criminal conviction. To monitor this effectively we would ask you to complete this form.

This form is separated from your application form, remains anonymous, confidential and is not seen by either the short listing or interview panel. The form is for monitoring purposes only.

What is your employment status?

Retired / Unemployed
Employed / Student
Non employed / Other

What is your ethnic origin?

White British / Bangladeshi
White Other / Pakistani
Black African / Chinese
Black Caribbean / Other European
Black Other / Other
Indian

Age Range

16 – 17 / 41-50
18 –20 / 51-60
21-30 / 61+
31-40

Gender

Male / Female

Do you consider yourself to have a disability?YES / NO

Do you consider yourself to be a Carer?YES / NO

Where did you see the post you are applying for advertised?

Thank you for your co-operation in completing this form. It will help us monitor our Equal Opportunity Policy. It will be separated from your application form upon receipt.