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St Marks Community Centre
218 Tollgate Road
Beckton
London E6 5YA
tel: 020 7474 3176

APPLICATION FORM
CONFIDENTIAL
POST / Healthwatch Manager (Newham)
CLOSING DATE FOR APPLICATIONS / 12 noon 3rd May 2013
Surname:
First Names:
Address:
Telephone No: / (home)
(work)
Please indicate what period of notice is required by your current employers
1 - Employment History
A - Latest Employment
Name & Address of Employer / From / To / Post & brief outline of duties
Reason For Leaving:
Latest Salary:
B - Previous Employment (see note 6)
Name & Address of Employer / From / To / Post & brief outline of duties
Reason For Leaving:
C- Previous Employment
Name & Address of Employer / From / To / Post & brief outline of duties
Reason For Leaving:
please continue on a separate sheet if necessary
2 - Qualifications and training undertaken of relevance to the post applied for:
3 - Describe any community activity or voluntary work you have been involved in which is of relevance to the post: (please give dates and name of organisation)
4 - Please state under each of the criteria listed what relevant skills or experience you would bring to this job: please continue on a separate piece of paper if necessary (see note 7)
5 - References (see note 5)
Please give the names and addresses of two referees: (one of whom should be your present or latest employer)
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Name:
Position:
Company / Organisation:
Address:
Telephone no:
In what capacity do you know this person:
Tick as appropriate: / / Do not contact until offered the post / / Do not contact until offered the post
/ Can be contacted now / / Can be contacted now
6 - If you have been convicted of any criminal record which is not spent, as defined by the rehabilitation of offenders act 1974, please give details: (see note 6)
Signed:……………………………………………………………..…… Dated:……………………………….
Please note: Giving incorrect information on this application could lead to termination of employment
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