APPLICATION FORM

Position applied for: Assessment and Allocations Coordinator (London)

Recruitment Reference No: 17.2

Closing date:

Where did you see the post advertised? ______

PERSONAL DETAILS

Forename(s) ______Surname ______Title ______

(Mr/Mrs/Miss/Ms/other)

National Insurance Number ______Date of Birth ______

Address ______

______

______Postcode ______

Home Telephone No______Day/Work Telephone No ______

(will be used with discretion)

Mobile Telephone No ______

E-Mail address______

Are there any restrictions on you taking up work in the UK? (If yes, please provide details).

______

AVAILABILITY

Notice required / Date available to start ______

EDUCATION

Name and location of Secondary School/ College/ University / Dates: from – to / Qualifications
Please state subject, qualification gained and grade
ADDITIONAL QUALIFICATIONS AND TRAINING

Give details about Professional Qualifications and other relevant courses (include any training courses and any studies you are currently undertaking). Continue on a separate sheet if necessary.

Dates: from - to / Course or Qualification obtained
CURRENT OR MOST RECENT EMPLOYMENT

Name and address of employer Position held ______

______From ______To ______

______(Month & Year)

______Present Salary ______

______Reason for leaving ______

______

______Main Duties______

______

______

______

CAREER HISTORY

Please give details of any other work/jobs/postings that you have held. Please list in chronological order (most recent first).

Employer’s name and address / Job title (include grade/rank) / Dates employed
from - to
(month & year) / Reason for leaving
Continue on a separate sheet if necessary

Have you ever been dismissed from previous employment? (for a reason other than redundancy)

Please tick appropriate box

Yes o No o

If yes, what was the reason(s) for dismissal? ______

______

______

UNACCOUNTED TIME

Please give details of any unaccounted time (including unemployment)

(Continue on a separate sheet if necessary)

STATEMENT IN SUPPORT OF APPLICATION

This section will provide us with specific information about your suitability for the post. It is very important that you read the enclosed Person Specification and Job Description, which outlines the criteria necessary to carry out the job in terms of abilities, skills, knowledge, qualifications and experience. Please show the selection panel clear evidence how you meet each of the criteria in this section.

(Continue on a separate sheet if necessary)

REFERENCES

Please give the names of referees who can provide information relating to your competency in the role applied for. One must be your current or most recent employer/line manager. The other should be from another employer/line manager. If you are applying for a role which involves unsupervised access to children or vulnerable adults, we reserve the right to approach any previous employer for a reference.

1.  CURRENT EMPLOYER’S REFERENCE 2. PREVIOUS EMPLOYER’S REFERENCE

Name ______Name ______

Surname ______Surname ______

Position ______Position ______

Address ______Address ______

______

______

______Postcode______Postcode______

Telephone No. ______Telephone No. ______

Email: ______Email: ______

Covering period from – to (month & year) Covering period from – to (month & year)

______

If you are shortlisted, we may contact your referees prior to interview. If you have any objection to this, place an ‘x’ in the box:

REFERENCE 1 o REFERENCE 2 o

BUSINESS INTERESTS

Please detail any business interests for which you receive any form of financial remuneration, in addition to your present appointment:

CAUTIONS, REHABILITATIONS AND CRIMINAL RECORDS

DECLARATION

1.  I confirm that the above information is complete and correct, and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.

2.  I agree that should I be successful with this application, I will apply to the Disclosure and Barring service for a disclosure. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of icap, any offer of employment may be withdrawn or my employment terminated

Signed ______Date ______

In accordance with the Data Protection Act 1998 any information provided will be held on file and can be accessed by the Personnel Department

Please return a copy of the completed application form and the copy of the Diversity Monitoring form to Brighde Barnes

Email:

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