APPLICATION FORM

Post Applied For:-

Received date: / Reference No.
Mr Mrs Miss Ms Dr Other / Surname / Forenames
Address / Postcode
Home telephone number
E-mail: /

Work telephone number

/ May we ring you at work?
Yes No
References
Please give details of two referees, one of whom should be your present or most recent employer
Name
Telephone number / Address
Postcode
How does this referee know you?
Name
Telephone number / Address
Postcode
How does this referee know you?
Eligibility to Work in the UK
I am eligible
Candidates will be required to prove this eligibility on production of valid passport/visa

Convictions

Please give details below of any conviction, including date and sentence imposed. Road traffic offences should be included. Because of the nature of the work for which you are applying,under the provisions of the Rehabilitation of Offenders Act 1974 (Exceptions)(Amendment) Order 2002, you are not entitled to withhold information about convictions which for other purposes are “spent”. The successful candidate will be required to provide a criminal record disclosure.
By signing and returning this application form you consent to Age UKDorchester or third parties such as referees using and keeping information about you relating to your application or future employment. This information will be used solely in the recruitment process and will be retained for 6 months from the date on which you are informed whether you have been invited for an interview. Such information may include details relating to ethnic origin and disability. These will be used solely for internal monitoring and will not be disclosed to any third party.
All applicants
Please sign here to confirm the accuracy of the information on this application form.

Signed

/

Date

Current employment
Or, if you are not currently employed, please give details of your most recent job
Name and address of current employer / Job title / Current salary
Full time / Part time
No. of hours? / Date you were appointed / Notice required
Summary of duties
All previous employment. Earliest first.

Please do not leave any gaps unaccounted for.

Name of employer / Job held/main duties / Reason for leaving

Continue on separate sheet if necessary

Education, qualifications and training
Education from age 12
School/College/University / Qualifications gained including grades
Other courses attended/attending
Organising body / Course title/subject detail
Do you have access to your own transport
Do you have a current driving licence

Other information

  • Please give details of any other relevant experience you have gained, whether paid or unpaid. Describe the specific skills you have which relate to this post: Remember we only have the information you put on this formso it is important to give us a good idea of your experience. Continue on a separate sheet if necessary.

  • Describe how your experience relates to the job description for the post.

  • Describe how you match up to the person specification for the post.

  • Describe any aspects of the job you feel less experienced in.

EQUAL OPPORTUNITIES MONITORING FORM

We aim to provide equal opportunities and fair treatment for all people applying to work with us. You can help us monitor how successful we are in achieving our aim by completing the form below. This information is separated from the rest of your application when we receive it. You do not have to complete this form. Age UK Dorchester is an Equal Opportunities Employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment because of age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

What is your sex ?

Male / Female

What is your ethnic group?

Please choose ONE section from A-E and then tick the appropriate box to indicate your cultural background.

A

/

White

/ British / Irish / Any other White background,
please write in

B

/

Mixed

/ White and Black Caribbean / White and Black African / White and Asian / Any other Mixed background,
please write in

C

/

Asian or Asian British

/ Indian / Pakistani / Bangladeshi / Any other Asian
background,
please write in

D

/ Black or Black British / Caribbean / African / Any other Black
background,
please write in
E / Chinese or other ethnic group / Chinese / Any other,
please write in

What is your date of birth?

Where did you see or hear about our advertisement?

C3/Personnel/Staff

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