CONFIDENTIAL
Application for employment
Please complete and return to:-
Lepra 28 Middleborough, Colchester, Essex, CO1 1TG
or Email to /
1.Position applied for: ______
How did you learn of this vacancy? ______
2.Personal details
Surname: ______Forename(s): ______
Address: ______
______
______Post code: ______
Telephone:Home: ______Mobile: ______
Email: ______
3. Other information
Are you currently eligible for employment in the UK?YES / NO
Please state what documentation you can provide in order to demonstrate this:
If you are not currently eligible for employment in the UK, please state grounds (special skills, etc) on which we might apply for a permit on your behalf:
Do you have a current driving licence?ProvisionalFullNo 
Do you have use of a car?YesNo
Do you have any current endorsements? (Give details)
4.Languages
Do you speak or read any foreign languages?YES / NO
Please give details:
5.Education and training - please give details relevant to this post and give some indication of your career objectives. Please continue on a separate sheet if necessary.
  1. Professional membership and qualifications:

7.Employment history(Please work backwards from your present/most recent employment. Continue on a separate sheet if necessary)
From
Month/Year / To
Month/Year / Employer and type of business / Please give: your job title, a brief outline of your duties and responsibilities and your reason for leaving
Present/Final Salary:
Present/Final Salary:
From
Month/Year / To
Month/Year / Employer and type of business / Please give: your job title, a brief outline of your duties and responsibilities and your reason for leaving
Present/Final Salary:
Present/Final Salary:
Present/Final Salary:
8.Other relevant skills and competencies - Please explain how you feel your skills and competencies match the needs of the post applied for. Please continue on a separate sheet if necessary.
9.Reasons for application / supporting information- please give your reasons for applying for this post and any other information you think relevant; continue on a separate sheet if necessary.
10.References - Please give three people, one of whom should be your present or most recent employer.
No approach will be made before an offer has been made and accepted.
Name and title/PositionAddressemailRelationship
  1. Recruitment policy
It is Lepra’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of their sex, sexual orientation, religion, religious belief, marital status, age, race, ethnic origin or disability.
I authorise Lepra to obtain references to support this application once an offer has been made and accepted.
Declaration: I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.
Signature:Date:
Appendix 1
Rehabilitation of Offenders Act 1974 (Exceptions Order 1975)
This post will require a Disclosure and Barring Service enhanced disclosure. Please provide details of any police inquiries made against you, which may have a bearing on your suitability for this post.
Having a criminal record will not necessarily bar you from working for us. This will depend on the nature of the post and the circumstances and background of the offence(s).
The information provided for this application will only be seen by staff involved in the recruitment process.
Have you ever been convicted of a criminal offence, cautioned, reprimanded or given a final warning by the police, or do you have any court cases pending? (Because of the nature of the work, this post is exempted from the Rehabilitation of Offenders Act 1974 and all convictions, both spent and unspent, must be disclosed).
Please choose:Yes / No
If yes, please give details, with dates, of offences, sentences, cautions, reprimands, final warnings and court cases pending:
Date of offence:
Nature of offence:
Sentence or nature of police or court sanction:
Equal opportunities monitoring.
Lepra requires all its managers and other employees to operate its policy of equal opportunity and not to discriminate against any person because of sex, sexual orientation, religion, religious belief, marital status, age, race, ethnic origin or disability.
Please note that this form will be separated from your application form in the personnel department and used in strictest confidence for monitoring purposes only. You are not obliged to complete this form.
Title
/ Full name
Date of birth / Male / Female
Position applied for:
Ethnicity
I would describe myself as: (please mark with ‘Y' for one of the following)
ASIAN / MIXED/DUAL HERITAGE
Bangladeshi / White & Asian
Chinese / White & Black African
Indian / White & Black Caribbean
Pakistani / Other Mixed Background
Vietnamese
Other Asian / WHITE
British
Irish
BLACK / Other White
Caribbean
African / OTHER
Other Black
Disability
Under the Disability Discrimination Act 1995, a person is considered to have a disability if he/she has a physical or mental impairment which has sustained or long-term adverse effect on their ability to carry out normal day to day activities.
Do you consider yourself to have a disability? / Yes / No
If yes, please give brief details of your disability:
Signature / Date