Please complete as fully as possible. CV and/or other materials will not be assessed.

Application for the post of:
Green Spaces Community Worker (part-time, fixed term)
Title: Mr ( ) Mrs ( ) Miss ( ) Ms ( ) Other:…….
Full Name: …..…………………………………………………………………………...
Address: ………………………………………………………………………………..
…………………………………………………………………………………
Phone: …………………………………Work: ……………………………………...
E-mail: …………………………………………………………………………………

May we contact you at work? Yes ÿ No ÿ

Notice Period (if relevant):

Employment History: Please outline below your employment details, including relevant voluntary work. Please start with you current or most recent experience. Always give the month and year your employment started and ended (e.g. From 01/2012 To 04/2015)
From / To / Name of organisation; job title, and brief description of duties / Reason(s) for leaving

(Continue on a separate sheet of A4 paper if necessary)

Further & Higher Education
From / To / Name of College/ University / Qualifications gained
Other Relevant Qualifications and Training
From / To / Name of Organisation; course or training / Qualifications earned if any

Continue on a separate sheet of A4 paper if necessary)

Statement in support of your application:

Please explain why you are interested in this position and organisation, and what skills and experience of a voluntary or professional nature you will bring to this post in relation to the Person Specification.

(Continue on a separate sheet of A4 paper if necessary)

Referees (Please provide details of individuals able to provide professional and character references, one of which should be from your present and/or most recent employer or most recent place of training or education. The professional referee must be someone who is authorised to comment on behalf of the organisation)
Name:……………………………………
Position:…………………………………
Organisation:…………………………..
Address:………………………………..
……………………………………………
Relationship:…………………………..
Phone:…………………………………..
May we contact without further notice or reference to you? Yes/No / Name:……………………………………
Position:…………………………………
Organisation:…………………………...
Address:…………………………………
…………………………………………….
Relationship:……………………………
Phone:…………………………………...
May we contact without further notice or reference to you? Yes/No

Disability: If you have a disability, is there anything we need to know in order to offer you fair selection interview, e.g. a signer or tape? Is there any equipment or support you may require to enable you to do this job that we would need to supply for you?

……………………………………………………………………………………………..

Are you registered disabled? YES/NO

Do you have a criminal record? YES/NO

Note to applicant:

In the event of a successful application for this post an Enhanced DBS Disclosure will be sought and you will be required to give details of spent and unspent convictions. Because of the sensitive nature of the duties the post holder will be expected to undertake, the Disclosure will include details of any criminal convictions, cautions, reprimands and final warnings, and any other information that may have a bearing on your suitability for the post.

DECLARATION:

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not employing me, or for immediate termination of employment at any point in the future. I authorise the verification of any or all information listed above.

Signature………………………………….. Date………………………………..

Please return completed form via email/hard copy by 5pm, Friday, 23rd June 2017, to:

Simon Vincent,

Community Development Coordinator,

PSBL,

c/o REIN, 478 Barking Road

London E13 8QB

______

FOR INTERNAL USE ONLY
Shortlist/
Decline with reason
Date of interview:
Panel members:
Decision with reason:

EQUAL OPPORTUNITIES FORM

REIN and PSBL are fully committed to the active promotion of equality and diversity in employment practises, in the work that they undertake and in the provision of all services. REIN treats all employees, service users and the children and young people with whom we engage fairly, irrespective of their age, gender, sexual orientation, ethnicity, faith, disability or impairment, including HIV status and mental health.

REIN needs to record these details which will only be used to fulfil its equal opportunities obligations and as a guide in building efficient recruitment strategies. The information contained in this form is completely confidential.

1.  Where did you hear about this position?
2.  What position are you applying for? / Green Spaces Community Worker (PSBL)
3.  Your age range (please tick box)
16 - 21 / 22 - 30 / 31 - 40 / 41 - 50 / 51 - 60 / 61 - 65 / 65+ / Not stated
4.  Gender /
Male Female
5.  How do you identify your ethnic group? Please tick the appropriate box or complete the section below
White UK /
/ White Irish /
/ White EU /
/ White other /
Black UK /
/ Caribbean /
/ African /
/ Black other /
Asian UK /
/ Pakistani /
/ Indian /
/ Bangladeshi /
Asian other /
/ Mixed /
/ Other(state) /
6.  Do you consider yourself to have a disability? /
YES NO PREFER NOT TO DISCLOSE INFORMATION
If ‘YES’ Please state the nature of the disability and whether you need any adjustments to be made in order to carry out this role/interview at the best of your abilities.
7.  If you wish, you may disclose information about yourself in this section about your religion and sexual orientation
Religion / Sexual orientation
Date form completed

By completing this form I understand that I give my consent under the Data Protection Act 1998 for this information to be processed in accordance with the REIN policy for the purpose stated above.

Disclosure and Barring Service (DBS) Checks – If your application is successful and you are offered employment with us you will be asked to consent to an Enhanced DBS Disclosure check by the Disclosure and Barring Service. This is to ensure we safeguard the children and young people and vulnerable adults we work with. You do not have to consent to these checks being carried out. However, if consent is withheld REIN will have the right to withdraw the offer of employment.

Data Protection Statement – The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process. We may check the information collected, with third parties or other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law.

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