October 2015

Pendle Action for the Community

Application Form – Part 1

Please complete all sections of this application form, use additional sheets if necessary but ensure that additional sheets have reference to the question you are answering. Please do not enclose CVs.Please return both parts of the application form.

Pendle Action for the Community, as an equal opportunity employer, intends that no job applicant or employee shall receive less favourable treatment because of his or her sex, age, marital status, race, colour, nationality, national origin, ethnic origin, faith, sexual orientation, or disability nor be disadvantaged by any other condition or requirement which cannot be shown to be justifiable.

Due to the nature of this work - all posts offered will be subject to disclosure & barring service (DBS) check

Post(s) applied for______

Forename(s) / ______
Surname / ______
Address / ______
______
______
______
Telephone Number / ______
Mobile Number / ______
Email / ______

National Insurance Number ______

Education and Qualifications

School / College

Name of
School/College / From / To / Qualifications Gained
(Please indicate level, awarding body, Subject(s),
Grades and Dates awarded)

Continue on separate sheet if necessary

Further Education / Higher Education

Name of College / University / From / To / Qualifications Gained
(Please indicate level, awarding body, Subject(s),
Grades and Dates awarded)

Continue on separate sheet if necessary

Additional qualifications / Courses

Name of Institution / From / To / Qualifications Gained
(Please indicate level, awarding body, Subject(s),
Grades and Dates awarded)

Continue on separate sheet if necessary

Employment Record

Present Post _

Hours per week? ______

Name and Address of Employer ______

______

______

Brief Description of duties undertaken

______

______

______

______

Starting Date in present post ______

If appointed on which date could you start? ______

Previous Employment

Dates / Position Held – brief description / Full time/Part Time / Name and Address of Employer / Reason for Leaving

Continue on separate sheet if necessary

References

References: Give below the details of 2 persons from whom references can be obtained – one should normally be your present employer. If your present employer is not a referee please indicate whether or not you are agreeable to her/him being approached for a reference in the event of you being short listed for an interview.

1.Name / 2. Name
Position/relationship to applicant / Position/relationship to applicant
Telephone / Telephone
Email / Email
Address / Address

Do you consider yourself to have a disability? Yes/No

Please tell us if there are any ‘reasonable adjustments’ we can make to assist you in your application or with our recruitment process

Do you hold a current Driving Licence? Yes/No

Do you have use of a car? Yes/No

Are you free to remain and take up employment in the UK?Yes/No

Have you ever been convicted of a criminal offence? Yes/No

Your attention is drawn to the fact that this post is covered under the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 and you should declare any convictions. If successful at interview, an Enhanced Criminal Record Certificate will be sought from the Criminal Records Bureau before confirmation of appointment. It is suggested that you take appropriate advice if you are in doubt as to the correct answer to give.

If you have answered yes, please specify date of conviction, court, nature of offence and sentence imposed. We request that this information is sent under separate, confidential cover, to the Charity Manager and we guarantee that this information is only seen by those who need to see it as part of the recruitment process.

Declaration

All the information I have provided is true and correct. I understand that by providing false information my application will be declared void.

Signed ______

Date ______

Please email your application (bothparts 1 and 2) to or mark your envelope confidential and return completed applications to:

Alicia Fitton, Business and Finance Officer, Pendle Action for the Community, Hills House, Leeds Rd,

Nelson, BB9 8EL

Where did you see the advertisement for the post?

______

Monitoring Information

In accordance with our Recruitment and Selection Policy, Pendle Action for the Community monitor all applications to ensure equality of opportunity.

The data supplied below will be separated from your application prior to shortlisting and will only be stored in anonymised form.

Do you consider yourself to be: Do you consider yourself to be:

White British / No Religion
White Irish / Christian
White European / Buddhist
White Other / Hindu
Black African / Jewish
Black European / Muslim
Black Other / Sikh
Asian – Indian / Any Other
Asian – Bangladeshi / Does not wish to Disclose.
Asian – Pakistani
Asian – Chinese
Asian – Other
Mixed - White/Black Caribbean
Mixed - White/Black Asian
Mixed - Other
Gypsy / Romany / Irish Traveller
Other – Arab
Other - Not defined above
Not disclosed

Do you consider yourself to be: Do you consider yourself to have:

Male / No Disability
Female / Physical Impairment
Transgender / Visual Impairment
Other / Hearing Impairment
Does not wish to disclose / Mental Health
Learning Disability
Progressive Disability (MS, Cancer etc)
Autistic Spectrum Disability
Does not wish to disclose

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