HCGC Application Form

Please complete this form as fully as possible. Do not enclose a CV. If unsure please refer to guidance notes.

POST APPLIED FOR:

PERSONAL DETAILS:

Surname ______Title ______
Forename(s) ______Address ______
______Postcode ______
Telephone No. ______(Evening) ______(Daytime)
Mobile Phone No. ______E-mail ______

Do you have any particular requirements in order to attend an interview? YES NO

If YES please give details

How did you find out about this post?

PERIOD OF NOTICE:

If you received an offer of employment from HCGC how soon could you start?

QUALIFICATIONS:

Please list all relevant qualifications you have obtained

Qualification / Level / Where Obtained / Date

TRAINING:

Include details of vocational or personal development courses you have undertaken

Name of Training Course / Details / Date

WORK EXPERIENCE:

Please give details of all relevant past and present work, either paid or unpaid. Please start with your current or most recent work.

Job Title / Main Duties / Paid/
Unpd / Name & Address of Employer / From / To

INFORMATION IN SUPPORT OF YOUR APPLICATION:

Please provide evidence demonstrating how you meet each of the criteria from the Person Specification sheet.

REFEREES:

Please provide the names and addresses of two referees. One of the referees should be your current or most recent employer.

First Referee / Second Referee
Name: / Name:
Address:
Phone No: / Address:
Phone No:
Relationship to you:
(e.g. current employer, colleague etc.) / Relationship to you:
(e.g. previous employer, client, friend etc.)

If you do not want one or both of your referees to be approached without your permission please tick the box(es) below.

First Referee Second Referee

DECLARATION:

I confirm that to the best of my knowledge the information I have provided in this application is correct and true. I realise that if at any stage it is found that I have deliberately given false or misleading information I am liable to be disqualified from further consideration for employment, or if appointed to be dismissed immediately and without notice.

Signature:______

Date: ______

Please return the completed application (marked Private and Confidential) form to:

Jamie Dickinson, HCGC, c/o Claremont Centre, Rolls Crescent, Hulme, Manchester M15 5FS

Closing Date:9.00amMonday 22nd April 2013.

If you received your application very late you may e-mail a version of your completed form to reach us in time at:

But you must also mail us a hard/paper copy!

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Please continue on a separate sheet if necessary.