EMPLOYMENT APPLICATION FORM

Please complete this form in full, using black ink and block capitals.
Post applied for: SUPPORT MENTOR Date:
Location of post:
24 UPTON STREET GLOUCESTER GL1 4JZ / Reference:
PERSONAL DETAILS
Last Name: / Title:
Forenames:
Previous names used in last 5 years:
Address:
Town:
County: / Postcode:
Telephone / Home: / Work:
Email / Home: / Work:
Please indicate which of the statements below is most appropriate to your circumstances and state your nationality:
I am a British/EU national and do not require permission to work in the UK
I am not a British/EU national but do not require permission to work in the UK because (please state):
I require a work permit to work in the UK
Please note that if you require a work permit you will have to provide documentary evidence at your interview.

DRIVING INFORMATION

Do you hold a valid driving license? Yes/No

Do you have access to a car? Yes/No

EDUCATION DETAILS
Please give details of your education and qualifications.
Qualifications and Grades / School/College/University/Place of Study / DateAchieved
Please note that you may be required to provide proof of qualifications at interview and that awarding bodies may be contacted.
EMPLOYMENT DETAILS
Please give details of your current role.
EMPLOYER(name and address) / Position held/responsibilities / Start date/
end date
Reason for leaving:
Present salary: / £ / Period of notice:
PREVIOUS EMPLOYMENT
Please give details of your previous employment – please also include any periods of unemployment. Please continue on a separate page if necessary.
EMPLOYER (name and address) / Position held/responsibilities / Start date/
end date
EMPLOYER (name and address) / Position held/responsibilities / Start /end date

ADDITIONAL INFORMATION

To enable us to decide whether you meet all relevant criteria, it is essential that you provide us with sufficient details of any experience and skills which demonstrate how you meet the requirements of this role, as detailed in our person specification/job description. Please continue on an additional sheet should you feel it appropriate.

CONVICTIONS

Have you ever been convicted of a criminal offence? (Please include any spent convictions under the Rehabilitation of Offenders Act 1974).

Yes □ No □

If ‘Yes’ please give details of conviction:

Please note that posts involving contact with children and young people are not exempt under the Rehabilitation of Offenders Act. As the post you are applying for requiresa Criminal Records Bureau Disclosure, any convictions, cautions or warnings should be included above. As part of the Transitions Support policy of obtaining DBS checks, when an Enhanced DBS check is carried out this includes a check with the Protection of Children’s Act List. This list is part of The Protection of Children’s Act 1999 and provides the names of people who are considered to be unsuitable to work with children and young people.

REFEREES
Please give the names and addresses of two people (one of whom should be your current or most recent employer) who can comment on your skills and qualifications for this post.
Present/most recent employer / 2nd referee
Name: / Name:
Position: / Position:
Capacity in which known: / Capacity in which known:
Address: / Address:
Postcode: / Postcode:
Telephone: / Telephone:
Email: / Email:
Fax: / Fax:
DECLARATION
To the best of my knowledge all the particulars I have given are true. I understand that any false statements may disqualify me from employment or render me liable to summary dismissal. I also understand that no offer of employment made to me will be binding unless confirmed in writing. For the purposes of the Data Protection Act 1998 I give my consent to the holding and processing of personal data provided by me to Transitions Supported Living Ltd for all purposes relating to the recruitment and employment process.
Signed: / Date:

Please return the completed form to:

Ginna Cox

Transitions Supported Living Ltd

24 Upton Street

Gloucester

GL1 4JZ

Any queries please email our offices at:

or call 01452 549270

EQUAL OPPORTUNITIES MONITORING FORM

Transitions Supported Living Ltd is committed to equality of opportunity and diversity in employment. In completing the form you are assisting us to assess the effectiveness of this policy.

Application for post of: / SUPPORT MENTOR / Reference:
Where did you see/hear about this job?
Last name: / Other names:
Date of birth: / Gender: / Male  Female 
Ethnic origin:I am
Asian or Asian British – Indian  / White – Irish 
Asian or Asian British - Pakistani  / Other White Background 
Asian or Asian British - Bangladeshi  / Mixed White and Black African 
Chinese  / Mixed – White and Black Caribbean
Other Asian Background  / Mixed – White and Asian 
Black or Black British – African  / Other Mixed Background 
Black or Black British – Caribbean  / Other Ethnic Background 
Other Black Background  / Not Known 
White – British 
DISABILITY – Please the box(s) from the list of statements below that is most appropriate to you. A disability or health problem does not preclude full consideration for the job, as any reasonable adjustments to the role will be explored. This information may need to be shared with the recruitment panel in order for them to consider any such adjustments. However, your permission will be sought before any disclosure is made.
I do not have a disability / I need personal care support
I have dyslexia  / I have mental health difficulties 
I am a wheelchair user/have mobility difficulties  / I have an unseen disability (e.g. diabetes, epilepsy/special needs 
I am deaf/have a hearing impairment  / I have a disability that is not listed 
I am blind/partially sighted  / Other – Please provide details below 
Details:

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