APPLICATION FORM

CONFIDENTIAL

Position Applied for:

Faith in Families is committed to equal opportunities andwe positively welcome your application irrespective of your gender, race,disability, colour, ethnic or national origin, nationality, sexuality, gender identity,marital status, responsibility for dependants, religion, trade union activity and age.

This form should be completed and emailed to: or post to: The Chief Executive, Faith In Families, 7 Colwick Road, West Bridgford, Nottingham, NG2 5FR Telephone: (0115) 9558811

PERSONAL INFORMATION (BLOCK CAPITALS PLEASE)

Title: Mr/Mrs/Ms/Miss/Other

Surname: / Forename(s):
Previous name (s):
Address:
Post Code:
At current address since: / Phone No (Home):
Phone No (Work): / Mobile Phone No:
Email Address: / National Insurance No:

EDUCATION/QUALIFICATIONS(Gained or being studied for)

School/College/University / Qualifications / Grades / Dates taken

RELEVANT TRAINING(Please list any courses which you have undertaken which are relevant to the job and/or specified on the person specification)

Organising Body / Course Details / Dates taken

MEMBERSHIP (Please indicate membership of any organisation(s) relevant to this job)

Name of organisation / Type of membership / Date of membership

PRESENT EMPLOYER

Name and Address of Employer: / Nature of Business:
Present Salary:
Grade:
Name and Address of Place of Work (if different from above) / Other Benefits:
Job Title:
If part time please state hours worked per week / Responsible to:
Date of Appointment:
Notice Required: / Reason for seeking other employment:
Brief Description of Duties:

PREVIOUS EMPLOYMENT:

Previous paid employment in chronological order

Post / From/ To* / Employer / Job Title and Key Responsibilities / Reasons for Change

*All candidates will be required to account for any gaps in their employment history

VOLUNTARY WORK______

Organisation and Nature of Business / From/ To / Role and Key Duties

Additional Information

Use the space below to provide any further information in support of your application. Please ensure that you address all of the criteria outlined in the Person Specification. Please use continuation sheets if necessary.

REFEREES

We require two referees, which, wherever possible, should be from previous employers with whom you have had at least one year’s service. One of your referees must be from your present employer as no offer of employment can be made without a reference from him/her. If you have not previously been employed then Head Teacher/College Lecturers etc. are acceptable as referees.

For students we must have a College/University and previous employer reference if possible.

Do we have your permission to approach referees given below, prior to interview? Yes No

Name: / Name:
Address: / Address:
Post Code: / Post Code:
Telephone No: / Telephone No:
Email address: / Email address:
Status: / Status:
How long acquainted / How long acquainted

GENERAL

1.0Are you a holder of a current driving licence? Yes No Do you own a car?Yes No

2.0Have you ever made a previous application for employment at this Agency? Yes No

3.0You are required to declare below any relationship with or to any member of the Board of Trustee or an employee of the Agency.

Please state name and position:

4.0Do you have the Right to Work in the UK? Yes No

Please note: original identification documents verifying your right to work in the UK will be requested, checked and a photocopy will be taken. If your application is successful and you commence employment the copy of your identification documents will be retained on file under the regulations governed by the Immigration, Asylum and Nationality Act.

5.0Should you be called for an interviewand/or work based exercise would you require any special arrangements? Yes No

If yes, please specify, (e.g. ground floor venue, sign language interpreter, audio tapes etc.)

6.0Where did you see the Advertisement? (Name of Publication)

7.0Is there any disciplinary action currently pending, or have there been any disciplinary actions instigated against you by a previous employer?

This information is required, including that related to warnings regarded as "spent" in order for the Agency to ensure safe recruitment and meet its obligations, for relevant appointments, to safeguard vulnerable users of the Agency's services. However, you should be aware that any disciplinary history declared will not automatically prevent or inhibit appointment and will depend on the dates and circumstances related to the disciplinary action, outcomes and the type of post being applied for. Note that you are also required to include information if you were subject to a disciplinary process but resigned before it was completed.

Yes If yes please give details and the outcome of such actionNo

8.0Have you ever been convicted of a criminal offence, or are you at present the subject of criminal charges or a police investigation? Yes If yes please give brief details: No

IMPORTANCE NOTICE
Because of the nature of the work which you are applying for, this post is exempt from the provision of section 4(ii) of the Rehabilitation of Offenders Act, 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order, 1975 and you are therefore not permitted to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the agency.

9.0Successful applicants will be required to complete a confidential medical questionnaire and may be required to undergo a medical examination. Details of your sickness absence will also be requested from your employment referee

Data Protection

The Data Protection Act 1988 (‘the Act) sets out certain requirements for the protection of your personal information against unauthorised use or disclosure. The Act also gives you certain rights. Except to the extent we are required or permitted by law, the information which you provide in this application form and any other information obtained or provided during the course of your application (the information) will be used solely for the purposes of assessing your application.

If your application is unsuccessful or you choose not to accept any offer of employment we make, the information will not be held for longer than necessary, after which time it will be destroyed, although relevant information will be retained in the longer term to facilitate our Equal Opportunity monitoring. If your application is unsuccessful, the information will form part of your employment file and we will be entitled to process it for all purposes in connection with your employment. So that we may use the information for the above purposes and on the terms, we are required under the Act to obtain your explicit consent. Accordingly, we would be grateful if you would sign the consent section below.

I CONSENT TO THE USE OF MY PERSONAL INFORMATION FOR THE PURPOSES AND ON THE TERMS SET OUT ABOVE.

Date: Signature:

FOR OFFICIAL USE ONLY:

EQUAL OPPORTUNITIES MONITORING FORM

Faith in Families operates a policy of equality of opportunity and fair treatment in employment.

We aim to ensure that unfair discrimination does not occur. To help us to achieve this aim, we ask you to complete this confidential monitoring form. Statutory codes of practice issued by Equal opportunities bodies recommend that employment practices monitor their policies are working effectively.

Please complete the form and return it with your application from. It will be removed from your application and the information provided will be used for statistical monitoring purposes only. It will not be seen by those who are responsible for making selection decisions.

  1. Are You: Male Female 30/39 40/49
  1. What is your age?16/1920/29 50/59 60/64 65+
  1. What is your ethnic Group? (Choose ONE section from A to E and tick the appropriate box to indicate your cultural background.

AWhiteB Mixed C Asian or Asian British

British White & Black Caribbean Indian

Irish White & Black Asian Pakistani

Other White & AsianBangladeshi

D Black & Black BritishE Chinese or Other Ethnic Group

CaribbeanChinese

AfricanOther

Other

  1. WHAT IS YOUR RELIGION OR BELIEF?

(As per employment Equality (religion or belief) Regulations 2003).

Christian Buddhist Hindu Jewish Prefer not to state

Muslim Sikh None Other

  1. DISABILITY

(As per Equality Act 2010)

If you have a medical condition, the Equality Act 2010 requires employers to make reasonable adjustments to the job content or working environment. To achieve this, we need to know whether you are covered.

Definition of Disability:

“A mental or physical impairment which has substantial and long-term effect on a person’s ability to carry out normal day-today activities in a non-work environment.”

DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY AS DEFINED IN THE EQUALITY ACT 2010?

YesNo

Thank you for completing this from. Please return it with your job application.

FOR OFFICIAL USE ONLY:

Application Number: ______

ShortlistedOfferedAccepted

1