Version: 3.3 May 2012
Application Form
Post applied for:___Service Manager (Queens Road, Northway and Briants Piece)______
Location: ____Newbury______Job Ref.: ______WBAug08-12______
General guidance notes:
- Please read these notes carefully. We will decide whether or not to interview you solely by the information you give in this application form.
- Study the form and read the information we provided before you start writing.
- Look carefully at the person specification. It sets out the skills, abilities, knowledge and experience required for the job. We will assess your application to see if you give evidence that you meet or can achieve these requirements.
- Complete the form truthfully andfullyusing black ink and BLOCK capitals. If typed capitals are not necessary.
- Do not include your CV or anything else with the form unless you have been asked to do so.
- Late or incomplete applications may not be considered.
Personal details
Please answer all questions. Telephone numbers are important as we may need to contact you.
Title:
(Mr/Mrs/Miss/Ms/ Other) / Surname:
Forenames: / Names previously known as:
Address
Postcode / Home tel No:
Mobile tel No:
Work tel No:
Email address
Do you have a full UK/ EU driving licence? / Yes/No / Do you have a car to travel to/ use at work if necessary? / Yes/No
For support/ care duties there is a statutory requirement for you to be 18 years old or older. Are you 18 or over? Yes/No
Hours of work
Would you like full-time or part-time work? / Full-time Part-time Relief/Bank
If part-time, how many hours do you want to work? / hours per week
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Version: 3.3 May 2012
Current or most recent employmentPlease enter all details of your current job here. If unemployed, please provide details of your last job.
Employer’s name: / Employer’s address:
Postcode:
Telephone no:
Position held: / Company email address:
Date employment
commenced: / Basic salary: £ per
Notice period required or date your employment ended:
Please give a brief description of the job and your responsibilities.
Please give your reason(s) for leaving or seeking new employment.
Full Employment History
- List all the employers you have worked for in date order, starting with the next most recent and dating back to your first job after education.
- For community, voluntary or unpaid work please list this as it may be used to assess whether you have relevant experience for the position you are applying for.
- Please indicate any gaps in employment e.g. career break, travelling, family commitments etc using the boxes at the end of the employment history section.
- We may request references from these employers.
Name of Company & full address / Job title / Dates employed from & to / Brief description of responsibilities and reason for leaving
Company:
Address:
Company:
Address:
Company:
Address:
Employment History Continued…
Name of Company & full address / Job title / Dates employed from & to / Brief description of responsibilities and reason for leaving
Company:
Address:
Company:
Address:
Company:
Address:
Company:
Address:
Gap in employment:
Date from:
Date to: / Reason:
Gap in employment:
Date from:
Date to: / Reason:
Please continue on the continuation sheet on page 9 if necessary.
ReferencesWe require a minimum of 2 references covering your last 2 years of employment before any offer of employment can be confirmed. Please provide details below of suitable referees (Line Manager or HR Representative) who we can contact to obtain these. Should you be offered a post, please make sure these individuals are aware we will contact them.
If you have been in your current/ most recent employment for more than 2 years, you must supply a reference from your next most recent employer. If you have worked for several employers during the last 2 years you must supply reference details for all these employers. We do not accept references from friends or relatives. If you are unable to provide the required employer references please supply contact details for a suitable person to give a character reference in the boxes below.
Employer Reference 1)
Company Name: / Company Address:
Full name and job title of referee: / Nature of relationship:
Telephone No: / Fax No:
Referee’s Company email address: (Preferred method of contact)
May we approach this individual before an offer is made? YES/NO
Employer Reference 2)
Company Name: / Company Address:
Full name and job title of referee: / Nature of relationship:
Telephone No: / Fax No:
Referee’s Company email address: (Preferred method of contact)
May we approach this individual before an offer is made? YES/NO
Employer reference 3)
Company Name: (If applicable) / Company Address: (If applicable)
Full name and job title of referee: / Nature of relationship:
Telephone No: / Fax No:
Referee’s Company email address: (Preferred method of contact)
May we approach this individual before an offer is made? YES/NO
Please continue on the continuation sheet on page 10 if necessary
Education, Qualifications and Training
In order to satisfy the requirements of our regulators in obtaining a full employment history, from the time each applicant left full time education we ask you complete this section. Please provide details of your full time education and dates of attendance listing all formal and informal qualifications. This information may be necessary to assess whether you meet the essential qualifications for the job. Include any relevant training, even if it has not led to any qualifications.
Place of attendance (school/university/work etc) / Dates of attendance / Examinations passed/Qualifications obtained/Training completed
Please give details of any professional memberships that are relevant to this post, including membership number:
General Information
If you are involved with any other work, employment, private business commitments or are responsible for running a business, then please provide brief details:
Please provide details of any relationships you may have with current or past members of staff, a member of the board of management or a person we support:
Have you been introduced to the organisation by a current employee. Please name.
Skills, abilities, knowledge and experience
It is important that we test your experience and gauge your potential against our needs. We have identified five key areas in which we think all employees need to do well. These are:
Working in partnership
Communication
Teamwork / Motivating self and others
Planning and organising
Specific skills, abilities, knowledge and experience that are needed for the job that you are applying for are identified in the person specification.
In the space below you should provide us with real examples of your skills, abilities, knowledge and experience. Use examples from your general life as well as from your current and previous work experiences (including unpaid and voluntary work) which will support your application. For each example be precise about what you did, why you did it and what the outcome was.
Skills, abilities, knowledge and experience continued
Interview adjustments
Please provide brief details of any adjustments you may require to be made to the interview/selection process. Any information provided will be treated in the strictest confidence and will only be used where necessary to facilitate the interview/ selection process:
Disciplinary action
Have you ever been dismissed from a post because of misconduct, or resigned pending the resolution of disciplinary proceeding against you? Yes/No
If yes, please provide details:
Nationality
Under the requirements of the Immigration, Asylum and Nationality Act 2006 we need to ensure that you are eligible to work in the UK before we can employ you. If you are unclear about the questions below please contact us for help. Proof of eligibility to work will be required at interview.Please note that Dimensions does not support sponsorship of its employees.
Are there any legal restrictions placed on you taking up work in the UK? Yes/No
You must answer ‘yes’ if you hold a visa or other document that allows you to work.
If yes,please give details of visas and work permits, including expiry dates:
If you have a right to work which expires and fail to provide a new document proving your right to work in the UK your employment will not be continued. By submitting the application form you give permission for us to contact the United Kingdom Border Agency to verify your immigration status and eligibility to work in the United Kingdom.
Rehabilitation of Offenders Act 1974
If this part of the form is not applicable to you, please select NO or write N/A.
Please do not leave this section blank.
Conviction, or caution, for a criminal offence(s) will not necessarily bar a person from consideration for appointment as each applicant is considered solely on his or her merits. However, failure to disclose a criminal conviction or a caution – even if that conviction or caution would not have barred a person from consideration – could lead to the application being rejected, an offer of appointment being withdrawn or employment being terminated depending on the time of the disclosure.
You are advised that you are not entitled to withhold information about convictions which are regarded as ‘spent’ under the Rehabilitation of Offenders Act 1974. This is because the nature of the work involved in this appointment renders the post exempt from Section 4(2) of the Act by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 (as amended). Information that you give will be strictly confidential and will be considered only in relation to this or similar exempted positions in the organisation.
Have you ever been convicted, cautioned, reprimanded or bound-over for a criminal offence?
Yes/No If yes, please give details (including ‘spent’ convictions):
NB: We are required by law to obtain a Criminal Record Disclosure for all employees working with vulnerable people ‘in a regulated activity’. You may be required to complete a disclosure form prior to joining the organisation.
Declaration
In accordance with the Data Protection Act 1998, I consent to, and in particular the processing of any “sensitive data” (as defined in the Data Protection Act 1998)including information relating to my racial or ethnic origin or religious or similar beliefs in order to monitor compliance with the equal opportunities legislation and information relating any criminal proceedings in which I have, or I am alleged to have been involved, being processed by Dimensions for legal, personnel, administrative and management purposes in connection with the recruitment for this or any other post.
I declare that the information provided in this application is correct to the best of my knowledge and, if I am appointed, will form part of my contract of employment. Any false information may be sufficient cause for rejection of the application, withdrawal of an offer of employment, or, if, employed, dismissal.
Signed: ______Dated:______
If you are completing this form electronically please tick this box to prove you agree to the above declaration.
When you have completed this form, please read it through, correcting any errors or inaccuracies, then sign and date it returning it to the appropriate addressor scan and email it back to the address provided to you.
Late or incomplete applications may not be considered.
Continuation sheetPlease specify which section you are continuing.
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