APPLICATION FORM /
Post Applied for:
  1. Personal Details (block capitals)

Title / Surname / First names
Have you ever used any other names? / Yes / No
If yes please state
Address / Telephone number (home)
Mobile
Telephone number (work)
Email (personal or work – please specify)
Do you hold a valid driving licence for use in the UK? / Yes / No
Type: / Provisional / Full / Other / Please specify
Do you have transport available if the duties of the post require you to travel? / Yes / No
  1. Current or most recent employment

Name and address of employer / Job Title
Current or last salary and grade
Weekly hours
Date started in post / Date of leaving (if relevant)
Notice required in current job / Reason for leaving
Brief description of duties
  1. Previous employment history – continue overleaf

Employer’s name and address / Dates from/to / Job Title and brief description of duties / Weekly hours / Reason for leaving
Employer’s name and address / Dates from/to / Job Title and brief description of duties / Weekly hours / Reason for leaving
  1. Breaks in employment history

If you have had any breaks in employment since leaving school, please give dates and details of your activities during these times e.g. unemployment, raising a family, study, voluntary work etc

Dates from/to / Reason for break
  1. Education and qualifications

If you are shortlisted for interview you will be asked to provide evidence of your qualifications

Dates from/to / Educational establishment / Name of course/qualifications gained and grades
  1. Membership of, or registration with, professional bodies

Name of professional body / Level/type of membership / Reg. number / Renewal date
  1. Other relevant training e.g. short courses, personal development, special projects

Date / Organising body / Brief description of course content
  1. Supporting information

It is important that you provide evidence in this section of how you meet the essential, very desirable and desirable criteria set out in the person specification. You may include brief examples from paid or unpaid work or other activities that are relevant. Please also explain your reasons for applying for this post. (Please continue on a separate sheet if you wish)

  1. References

Please give below the name and address of two people who would be willing to supply a reference for you.

Ref. 1

Name: / Telephone
Organisation / Position
Address
Email:
May we approach your referee without asking you first? / Yes / No

Ref. 2

Name: / Telephone
Organisation / Position
Address
Email:
May we approach your referee without asking you first? / Yes / No
  1. Arrangements for people with disabilities

If you have a disability and have demonstrated in your supporting information that you meet the minimum (essential) criteria for the vacancy you will be invited for interview.

We will make reasonable adjustments to the recruitment and selection process (and to the job for successful candidates) if you let us know what your requirements are.

Do you have a disability? / Yes / No
Are there are any special facilities you would like us to provide to help you attend or participate in an interview, or to perform this job? / Yes / No
If ‘yes’, please give details here:
  1. Rehabilitation of Offenders Act

Have you ever been convicted of a criminal offence? / Yes / No
  1. Immigration Asylum and Nationality Act 2006

Do you have any restrictions on taking up employment in the UK?
If yes please provide details on a separate sheet.
We will ask all candidates at interview to produce evidence of entitlement as required by the Act. We will give full details of what is required prior to interview. / Yes / No
  1. Declaration

I confirm that I have completed this application form honestly, and the information I have provided is true and accurate, and I understand that this shall be the basis of any offer of appointment.

Data Protection Statement: I consent to this information being processed and stored for the purpose of recruitment and selection at NCLS, and if appointed, for the purposes of employment at NCLS.

Signed______Date ______

Please return this form,marked NCAN application, to:

or by post to :

Ros Brown

Norfolk Community Law Service

Boardman House

Redwell Street

NORWICH

NR2 4SL