Interview Please List Any Dates When You Will Be Unavailable for Interview

Return Address- Please return this form to:
Age UK Faversham and Sittingbourne
2 Middle Row
Faversham
ME13 7AJ / Job Title:
Title: / First Name: / Last Name:
Address:
Postcode:
Home Telephone Number:
Can we call this number? Yes / No / Other Contact Number:
Can we call this number? Yes / No
Driving Licence
Do you have a full current driving licence? Yes / No / Do you have the use of a car? Yes / No

Right to Work– Interviewed applicants will be required to provide documentary evidence of their right to work in the United Kingdom. Do you have the right to work in the United Kingdom? Yes / No

References - Please give the names of two people who are not related to you who can provide a reference about your suitability. The first referee should be your present/last employer if you have been employed before.
1) Name:
Address:
Postcode
Tel No:
E-mail: / 2) Name:
Address:
Postcode:
Tel No:
E-mail:
How long have you known this person? / How long have you known this person?
May we take up references without
contacting you beforehand? Yes / No / May we take up references without
contacting you beforehand? Yes / No

Interview– Please list any dates when you will be unavailable for interview.

Are you related to anyone who works for Age UK Faversham and Sittingbourne? If yes please state who:
Current or Last Occupation
Name and address of current/last employer / Job Title:
Date of appointment:
Period of notice required:
Reason for Leaving:

Other Current and Previous Positions

Please list all other current and all previous positions, starting with the most recent first. Please continue on a separate sheet if necessary. Please explain any gaps in employment.
Date
from / Date
to / Employer / Post held / Reason for leaving

Education, Training Courses and other Qualifications

Please list all qualifications and training courses that you feel are relevantto the job, this could also include any short courses that you have undertaken.
Date(s) / Level / Subject/Course Title
Successful applicants may be required to provide proof of qualifications or training.

Voluntary Work Experience

Personal Statement
Before completing this section, please read the Person Specification, the Job Description and any other further information that has been sent out with this pack.
Skills, Abilities, Knowledge and Experience:please demonstrate how you meet the requirements in the Job Description and thePerson Specification.
Reasons for Applying:please say why you are interested in this post.

Data Protection Act 1998 -. I consent to Age UK Faversham and Sittingbourne using and keeping information I have provided on this application and elsewhere as part of the recruiting process and/ or personal information supplied by third parties such as referees, relating to my application or future employment. I understand that the information provided will be used to make a decision regarding my suitability for employment and if successful the information will be used to form my personnel record and will be retained for the duration of my employment. If I am not successful, I understand that Age UK Faversham and Sittingbourne will retain the form for as long as deemed necessary and that they may use it to contact me in the event of there being any other vacancies for which I may be suitable.

Signature- I certify that to the best of my knowledge, the information given on this form is correct. I understand that my application may be rejected or that I may be dismissed for withholding relevant details or giving false information. I also understand that the information I have provided may be subject to checking.

Signature: Date:
Please ensure that you complete this form fully. Do not submit your CV as they will not be taken in to account.

Convictions and spent convictions of a criminal nature
You will appreciate that this organisation is responsible for the provision of services to vulnerable older people living in the community. It is therefore essential that, in making your application, you disclose whether you have ever been convicted of a criminal offence, and if so, for what offence(s).
Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (exemptions) 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are “spent” under provisions of the Act and, in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by this organisation. The fact that the conviction(s) have been recorded against you will not necessarily debar you from consideration for this appointment.
You are therefore asked to answer the following:
Have you ever been convicted of a criminal offence? YES/NO
If the answer is ‘YES’ you must give details which may, if you wish, be enclosed in a separate sealed letter marked ‘ Confidential’. Any information will be treated in the strictest confidence. A copy of this notice will be sent to your referees.
PLEASE NOTE: All posts are subject to the DISCLOSURE policy established under the Care Standards Act 2000 that requires all those who work involves caring for vulnerable people to undergo a Police Check.
DECLARATION
I CONFIRM THAT THE INFORMATION I HAVE GIVEN IS CORRECT AND THAT I UNDERSTAND THE DISCLOSURES REQUIRES UNDER THE REHABILITATION OF OFFENDERS ACT 1974
Signed______Date______