Southam Youth Club

Southam Youth Club

@Graham Adams Centre

Application Form

Application for the post of: / Youth Club Leader
Closing Date: / Thursday 31st August
Interviews: / Week beginning 4th September

Instructions for completion

Please use black ink, or typescript so that the form can be photocopied.

Please answer all the questions - if you are completing by hand and you need more space, please use separate sheets of paper and attach them firmly to this form.

Applications should be returned to the Administrator at the Graham Adams Centre. Post to the Graham Adams Centre, St James’ Road, Southam, CV47 0LY or email to

Information given on this form is confidential and covered by the Data Protection Act 1998

Personal Details
Name
Address
Telephone Number (home)
Telephone Number (mobile)
Email Address
National Insurance Number
Employment Experience
Please give details of your employment, starting with your current or most recent job. Continue on a separate sheet if necessary.
Name and address / Job title and main duties / Dates and reason for leaving
Other relevant experience
Please give details of any other experience relevant to the position you are applying for, such as voluntary or community work
Qualifications and Education
Please give details of qualifications relevant to this position
Date / Qualification / Subject / Grade / Level / School / College
Other Training
Please give details of training you have completed which is relevant to this position.
Training Course / Organising body / Duration / Date completed
Other relevant experience
Please give your reasons for applying for this job, relating your qualifications, experience and personal attributes to the job description. You may also wish to relate your leisure or spare time interests. If necessary, please continue on a separate sheet.
Referees
Please give details of two referees, one of which should be your present / most recent employer (references will not be accepted from relatives or friends). Appointments are not confirmed until satisfactory references have been received.
Name
Position
Address
Telephone Number
Email Address
Can be contacted before interview? / Yes / No / Yes / No
HealthInformation
If you have been absent from work due to sickness or hospitalisation in the last two years, please state the number of days absent, and reasons
Disability Information
The Graham Adams Centre is committed to being an equal opportunities employer please let us know any adjustments that will be required to attend interview or complete this role
Sessions applied for
We are looking to recruit an assistant for both Tuesday and Thursday evening sessions, please indicate which evenings you are applying for
Tuesday / Thursday / Both
Signature
I understand providing false information is an offence, and could result in the application being rejected, or dismissal if selected for appointment
Signed:Date: