Application Form

STRICTLY CONFIDENTIAL - APPLICATION FOR EMPLOYMENT WITH AGE UK HAMPSIRE AND ISLE OF WIGHT TRADING COMPANY

Registered Address: The Bradbury centre, 16-18 Kingston Rd, Portsmouth PO1 5RZ
Isle of Wight Outlet: 147 High Street, Newport, Isle of Wight, PO30 1TY
IW Telephone: 01983 525282
Important Information:
a) Please answer all questions
b) Please complete clearly in black ink or type
c) Your completed Application Form and Equal Opportunities Monitoring Form to be received on or before the closing date and should be emailed where possible to: , or posted to the address above
d) Offers of employment are subject to receipt of satisfactory references, your proof of right to work in the UK, and if appropriate to the job role a Disclosure & Barring Service check
e) If offered employment, you will be required to complete a Medical Questionnaire
f) If offered employment, you will be required to provide copies of your Driving Licence, Vehicle Insurance showing business use and MOT Certificate if appropriate to your job role
POSITION APPLIED FOR: Business Development Supervisor
1.  PERSONAL INFORMATION
Surname
Title
First Name
Address
(including Postcode)
Telephone (home)
Telephone (mobile)
Email
2.  CAR OWNER
Do you have a full current driving licence? / Yes / No
(delete as appropriate)
Do you have any endorsements? / Yes / No (delete as appropriate)
If yes please provide details
Are you a car owner / have daily access to a car? / Yes / No (delete as appropriate)
Where staff are required to use a car as part of their role, they are annually required to provide copies of their driving licence, MOT certificate, and vehicle insurance showing business use
3.  PREVIOUS EMPLOYMENT WITH AGE UK ISLE OF WIGHT
Have you worked for Age UK before? / Yes / No (delete as appropriate)
If yes please give brief details
Have you applied for employment with Age UK before? / YES / NO Delete as appropriate
If yes please give brief details
4.  PRESENT OR LAST EMPLOYER
Name of current or most recent employer
Address
Telephone number
Position held
Brief description of duties
Dates of employment
Reason for leaving
Current / leaving salary
Notice period
5.  PREVIOUS EMPLOYMENT (in chronological order, giving exact dates)
Dates / Name & Address of Employer / Post Held & Brief Description of Duties
6.  EDUCATIONAL BACKGROUND (in chronological order)
Name / Examinations Passed & Grades
Secondary School
College / University
Other relevant training
7.  PUBLIC DUTIES (Please give details of any public service duties which you are required to perform e.g. JP, member of local authority, etc.)
8.  CRIMINAL CONVICTIONS
Have you ever been convicted of a criminal offence? / Yes / No (delete as appropriate)
If yes please give brief details
9.  HOW DID YOU HEAR ABOUT THE POST?
10. REFEREE DETAILS (1) (If possible please list referees from two latest employers)
Name
Position / Relationship to you
Address
Email address
Telephone number
REFEREE DETAILS (2)
Name
Position / Relationship to you
Address
Email address
Telephone number
11. SUPPLEMENTARY INFORMATION Continue on an extra sheet if necessary.
This is your opportunity to state why you are interested in this post, and what skills and experience you would bring to it.
Please confirm whether you are applying for this position full time or as a job share. If job share please confirm the maximum hours you are able to work.
Supplementary Information (continued)
12. DECLARATION
I understand that the information given on this form is true and correct and understand that any deception could result in instant dismissal if appointed. I understand that these details are held in confidence by Age UKHIW TC, for the purposes of ongoing personnel administration and payroll administration in compliance with the Data Protection Act 1998. I undertake to notify Age UKHIW TC immediately of any changes to the above details.
Print name
Signature
Date

Equal Opportunities Monitoring Form

We are an equal opportunities employer and as such we ask candidates to complete and return this Equal Opportunities Form. If you prefer, you may return this form in a separate envelope.

The data gathered will help us to monitor the effectiveness of our Equal Opportunities Policies & Procedures. The information will be held and processed separately to your application and in accordance with the Data Protection Act 1998.

THIS INFORMATION WILL HAVE NO IMPACT ON THE FINAL RECRUITMENT DECISION.

In each section listed below, please choose one option by making ‘x’ in the appropriate box.

Age:

16 - 17 / 18 - 21 / 22 - 30 / 31 - 40
41 - 50 / 51 - 60 / 61 - 65 / 66 - 70
71 + / Prefer not to say

Disability:

The Equality Act 2010 defines a disability as a physical or mental impairment that has a substantial and long-term adverse affect on an individual’s ability to carry out normal day-to-day activities.
Do you consider that you have a disability?
Yes / No / Prefer not to say

Gender:

Male / Female / Prefer not to say

Marital or Civil Partnership Status:

Married / In a registered civil partnership
Not married / in a civil partnership / Separated
Divorced / Widowed
Prefer not to say

Ethnic Group

Asian / Asian British / Black / Black British
Bangladeshi / African
Chinese / Caribbean
Indian
Pakistani
Other Asian background (please specify / Other Black background (please specify)
Mixed Ethnic Group / White
White and Asian / White British
White and Black African / White Irish
White and Black Caribbean
Other Mixed background (please specify) / Other White background (please specify)
Other Ethnic Group (please specify)
Prefer not to say

Sexual Orientation:

Bisexual / Homosexual / Gay / Lesbian
Heterosexual / Prefer not to say

Religion or Belief:

Buddhist / Christian
Hindu / Jewish
Muslim / No religion
Sikh / Prefer not to say
Other religion or belief (please specify)

Data Protection:

By completing this form, I agree to the organisation holding and processing the data I have provided, for its legitimate business reasons stated above.

Position Applied for:
Date of application:

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