When completed please return to:

Cumbria CVS

6 Hobson Court

Gillan Way

Penrith CA11 9GQ

or email

Post: Chief Executive Officer

Location: Carlisle

Where did you see the advertisement? …………………

First Name(s) ………….……………………………………..………

Surname……………………………………………………………..

Preferred Title …………………..(e.g. Mr/Ms/Mrs/Miss/Dr)

Address ………………………………………………………………………………………………..

…………………………………………………………………………………………………………...

………………………………………………………… Post Code ………………….…………….…

E-mail address …………………………………………………………………………………..……


Telephone number: (Daytime) …………………….. (Home)…………………………………..…

Mobile: ………………………………...………………

Do you require a work permit to take up this appointment? Yes/No


References

Please give details of two people from whom we can obtain references, at least one of whom should be your present or most recent employer (neither should be a family member).

Name
Position
Tel No
Email
Address

It is Cumbria CVS policy to take up references prior to interview.

If you do not wish your employer to be contacted at this stage, please tick the box

I hereby certify that to the best of my knowledge the details given in this form are correct. I understand that in the event of my being offered employment with Cumbria CVS, any proven falsification, or concealment of any material fact in respect of my application may lead to Cumbria CVS withdrawing the offer of employment if employment has not yet commenced or disciplinary action and dismissal if employment has commenced.

Signature …………………………….……………… Date …………………………………

If applying by email, please confirm by ticking box

We do value your application, but in order to save resources we do not acknowledge applications.

If you receive no further communication within four weeks of the closing date, you may assume that you have not been shortlisted on this occasion.

May we take this opportunity to thank you for your interest in the post.

Education and Training relevant to this position (please give details and dates)

Professional qualifications (include grade of membership and date of award)

Employment

Please give details of all previous employment starting with your present (or most recent) employer. There should be no gaps in your history.

Present/most recent employment

Dates
From/To / Employer’s Name, Address and nature of business / Job Title / Reason for Leaving

Notice required ……………………………

Please state current salary or most recent salary if not currently employed £ …………….………

Previous Employment

Dates From/To

/ Employer’s Name, Address and nature of business / Job Title / Reason for Leaving


Supporting Statement

Please ensure that your statement addresses the criteria listed in the Person Specification. We value life skills and un-paid work, so please include reference to these if relevant. (Please submit up to 2 x A4 pages of typed/written information.)

1

CCVS REC002 v2 March 2012

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