BASPCAN

The British Association for the Study and Prevention of

Child Abuse and Neglect

For Office Use Only
Vacancy No.
Applicant No.

CONFIDENTIAL

APPLICATION FOR EMPLOYMENT

Post Applied For
Please advise where you saw this post advertised(all sources)
Notes for Guidance
Please read the notes enclosed for your information with the application form.
Canvassing of Trustees or employees of BASPCAN in connection with an appointment will disqualify an applicant.

SECTION A - PERSONAL DETAILS
PERSONAL DETAILS
Surname:
Title for correspondence (Mr, Mrs, Ms, Dr etc):
Home Address:
Home Tel. No: / Forename(s):
Post Code:
Work Tel No:
National Insurance Number:

Do you hold a current valid driving licence? Yes No
Or the means to travel on public transport. Yes No
EDUCATION/QUALIFICATIONS
Dates Attended Secondary School / Qualifications Obtained / Grade
From / To
Dates Attended
College/University / Name of College/University / Qualification Obtained
From / To


SECTION A - PERSONAL DETAILS (cont.)
/ MEMBERSHIP OF PROFESSIONAL BODIES
Professional Body / Category of Membership / Date of Admission
SECTION B - EMPLOYMENT DETAILS
/ CURRENT EMPLOYMENT
Current Post Title:
Date of Commencement in Post: / Current Salary:
Employer’s Name and Address:
Post Code:
Period of Notice Required:
Please give outline of your current duties:
SECTION B - EMPLOYMENT DETAILS (Cont.)

PREVIOUS EMPLOYMENT Please list in date order with the most recent first
Post Title / Employer’s Name / Dates / Outline of Duties and
and Address / From / To / Reasons for Leaving


SECTION C – Personal Statement to provide evidence on meeting the requirements of
the Person Specification. This is an opportunity to provide evidence of your skills and experience. Please give specific examples and explain how these relate to the requirements outlined.
SECTION D - MISCELLANEOUS
REFERENCES
One of whom must be your current or most recent employer.
Referee 1 / Referee 2
Name:
Address:
Post Code: / Name:
Address:
Post Code:
Tel No: / Tel No:
Relationship: / Relationship:
Can referees be contacted prior to interview?

Referee 1 YES NO / Referee 2 YES NO

1. REHABILITATION OF OFFENDERS ACT 1974
Do you have any criminal convictions or impending charges against you?
YES NO (This will not necessarily discount you from being considered for the post).
2.RELATIONSHIP TO TRUSTEES
Please give details of any elected member or employee of the BASPCAN to whom you are related. Deliberately omitting to make such a declaration will disqualify an applicant or lead to dismissal if discovered after the appointment.
Name: / Relationship:

3. SOURCE OF APPLICATION
Please specify how this vacancy came to your attention, including, if appropriate, the publication.
Please note that the successful candidate will be required to have a satisfactory Disclosure and Barring Service (DBS) clearance.
I believe the information given on this form to be correct and understand that any false statement may disqualify me from appointment or may render me liable to dismissal.
Signature: / Date:
PLEASE EMAIL THIS APPLICTION FORM TO:
Celean Camp, BASPCAN Director, at
BASPCAN - CONVICTIONS FOR CRIMINAL OFFENCES
Post applied for:
Surname: / Forename(s)
Other Name(s):
(by which you are/have been known, including maiden name)
Place of Birth:
Current Address:
Post Code:
Duration of residence at Current Address:
From:
Previous Address:
1. / 2.
Post Code / Post Code
From: / To: / From: / To:
The nature of the duties of the post for which you have applied requires confirmation that you have had no convictions for offences which would reflect upon your suitability for appointment. You should therefore detail below any previous convictions for criminal offences. Subject to the provisions of the Rehabilitation of Offenders Act, 1974, failure to disclose a relevant conviction will be classed as gross misconduct and will result in dismissal.
It should be noted that:
“By virtue of the Rehabilitation of Offenders Act, 1974 (Exceptions) Order, 1975, as amended by the Amendment Order 1986, does not apply tot he undernoted question. YOU ARE THEREFORE NOT ENTITLED TO WITHHOLD INFORMATION ABOUT A PREVIOUS CONVICTION ON THE GROUNDS THAT IT IS FOR OTHER PURPOSES “SPENT” UNDER THAT ACT.
Have you ever been convicted of any crime? / Yes* / No
*If YES, give particulars as follows:
Court at
Which Convicted / Date of
Conviction / Details of
Conviction / Sentence
Imposed

Are there any criminal proceeding pending against you? Yes* No
*If YES, give details:
I hereby consent to BASPCAN arranging for a check to be carried out against Police records.
Signature: Date:

EQUAL OPPORTUNITIES MONITORING

In order to assist BASPCAN in ensuring that all applicants are treated equally, regardless

of sex, marital status, age, disability and race, you are requested to complete the short questionnaire

below. The information will not be taken into account in selecting candidates for interview and will

not be made available to employing services for the interviewing panel.

Surname: / Forename(s):
Title of post applied for:
Vacancy No:

PLEASE TICK THE RELEVANT BOX OR ANSWER YES/NO AS APPROPRIATE

1.I am Male  Female

2.I amSingleMarriedSeparated  Divorced Widowed

3.Dateof Birth: ......

4.I am White

Black - African

Black - Caribbean

Black - other (please specify): ......

Indian

 Pakistani

Bangladeshi

Chinese

Other (please describe): ......

5. Do you have a disability? Yes  No

If YES, please specify: ......

6. Are you registered disabled?  Yes  No

If YES, please give registration number:......

THANK YOU FOR YOUR ASSISTANCE

BASPCAN FORM DA/1

APPLICANTS WITH DISABILITIES

As part of the BASPCAN’s commitment to Equal Opportunities, applicants
who have disability* are guaranteed an interview - provided the essential qualification
and experience requirements for the particular post are met.
Accordingly, all applicants with disabilities are requested to complete the lower portion
of this form, in order that the necessary arrangements may be made.
Please return the completed document, together with your completed application form.
*Definition of a disability under the Equality Act 2010 : ‘A physical or mental impairment which has a substantial long term negative effect on your ability to do normal day to day activities.’
CONFIDENTIAL / DATE:
POST TITLE/SERVICE:
LOCATION:
NAME OF APPLICANT:
ADDRESS:
NATURE OF DISABILITY:
ATTENDANCE AT INTERVIEW:
- detail special needs (if any)