Healthwatch North Tyneside application form

Please return this form marked private and confidential to:

Jenny McAteer, Healthwatch North Tyneside, Parkside House, Elton Street East, Wallsend, NE28 8QU (we do not accept CVs)

or

Application for the post of:

Finance and Administrative Officer at Healthwatch North Tyneside

Personal details

Name
Address
Contact details / Email

References (please provide the names of two referees who we may contact)

Name
Address
Contact details / Phone / Email
How do you know them?

Can we contact before the interview? YES

Name
Address
Contact details / Phone / Email
How do you know them?

Can we contact before the interview? YES

One referee should be your current or most recent employer or, if you have no employment history, from a lecturer, teacher or other appropriate professional.

Training and experience

Education and Professional Qualifications

Academic qualifications
Course / Awarding Body / Dates
Professional training
Course / Awarding Body / Dates
Relevant training
Course / Awarding Body / Dates

Current and previous employment

Please start with current or mostecent employment

Job Title / Name of employer / Dates
– From and To / Reason for leaving
Additional Information
1. Are you related to a Healthwatch North Tyneside Board member or member of staff? Yes/No
If yes, please give details.
2. Are you an EEA (European Economic Area) National? Yes/No
If no, will you require a work permit for this employment? Yes/No
If no, what is your current work permit status (for example working holiday visa)?
3. Do you have a disability of which we should be aware? Yes/No
Would you require any assistance or adjustments to attend an interview?
If yes, please specify:

Evidence of the expertise required

Describe how your experience, skills, training and outside interests such as voluntary work, leisure activities and hobbies help you to meet the requirements of the person specification.

Please continue on the next page and on a separate sheet if necessary.

Evidence of the expertise required (continued)

Declaration

Rehabilitation of Offenders Act 1974

Due to the nature of the organisation’s work, an enhanced Disclosure and Barring Service check will be carried out on all successful applicants. Under section 4 (2) of the Rehabilitations of Offenders Act 1974 (Exception Order 1975) all spent convictions must be declared.

Have you ever been convicted of a criminal offence (including bind overs, cautions or charges not yet disposed of)? Yes/No

If yes, please specify:

The information in this form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal.

I agree to the above declaration
Signature
Name / Date

Monitoring information

This section will be detached from your application form. The information collected will only be used for monitoring purposes in an anonymised format and will help the organisation analyse the profile and make up of applicants and appointees to jobs in support of their equal opportunities policies.

We recognise and actively promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. We therefore welcome applications from all sections of the community.

Date of Birth
Gender /  Male
 Female
 I do not wish to disclose this
I would describe my ethnic origin as:
Asian or Asian British
 Bangladeshi
 Indian
 Pakistani
 Any other Asian background
Black or Black British
 African
 Caribbean
 Any other Black background / Mixed
 White & Asian
 White & Black African
 White & Black Caribbean
 Any other mixed background
White
 British
 Irish
 Any other White background / Other Ethnic Group
 Chinese
 Any other ethnic group
 I do not wish to disclose this information

The Equality Act 2010 protects disabled people - including those with long term health conditions, learning disabilities and so called ‘hidden’ disabilities such as dyslexia. If you tell us that you have a disability we can make reasonable adjustments to ensure that any selection processes - including the interview - are fair and equitable.

Do you consider yourself to have a disability? / Yes/No
 I do not wish to disclose this information
Could you please tell us where or how you found out about this opportunity?
For example press, website, social media, enewsletter,word of mouth.
Please give the website address or publication title as this helps with future recruitment advertisements.

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