APPLICATION FORM

Please fill all sections of the form.

SEction A: Personal Information
Position applied for:
Title: / First Name: / Surname: / D.O.B:
Street Address:
Town/City: / County: / Postcode:
Mobile: / Email address:
Nationality: / Ethnicity: / Gender:
Do you have a criminal record: Yes No
If yes, please outline the nature of any convictions:
SECTION B: CURRENT EMPLOYMENT AND VOLUNTARY ACTIVITIES
Are you currently employed? Yes No / If yes, how many hours/week do you work?
Job Title: / Organisation Name:
Current salary per annum: / Notice period required:
Are you involved in any volunteering? Yes No / If yes, how many hours/week do you volunteer?
SECTION C: SKILLS AND EXPERIENCE
Please list any languages you speak and the proficiency:
Please indicate your proficiency in the following:
Microsoft Word / Basic/ Proficient / Excellent (delete as appropriate)
Microsoft Excel / Basic / Proficient / Excellent (delete as appropriate)
Microsoft PowerPoint / Basic / Proficient / Excellent (delete as appropriate)
Microsoft Outlook / Basic / Proficient / Excellent (delete as appropriate)
Microsoft Access / Basic / Proficient / Excellent (delete as appropriate)
Social media (i.e. Twitter, Facebook) / Basic / Proficient / Excellent (delete as appropriate)
CRM software / Basic / Proficient / Excellent (delete as appropriate)
SECTION D: PERSONAL STATEMENT
Please describe why you are suitable for the role, how you meet the job specification and what you will be able to offer MYH
SECTION E: REFEREES Please list contact details for two referees, one of which must be in a professional capacity.
Referee 1:Please state in which capacity you know this referee: / Referee 2: Please state in which capacity you know this referee:
Title: / Full Name: / Title: / Full Name:
Job Title: / Job Title:
Company Name: / Company Name:
Street Address: / Street Address:
Postcode: / Postcode:
Phone: / Email: / Phone: / Email:
DECLARATION AND SIGNATURE
I confirm that all information given is correct and true and any information found to be incorrect or misleading could lead to the termination of any subsequent agreements.
Signature: / Date:

As part of your application to this post, you are required to submit a CV with full information about your educational experience and qualifications, current and previous employment, voluntary activities and additional skills and attributes. Please also include two references from the referees listed above.

Please submit all documents by email to:

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OFFICE USE ONLY
Date of receipt of application
Short listed
Date of Interview
Interviewees
References taken up
Outcome of Interview
Date notification of outcome sent
APPOINTMENT DETAILS
Position grade
Salary
Employment start date
Signed
Dated

1

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T: 0207 435 8171 E: Helpline: 0808 808 2008