CONFIDENTIAL

THE CAMDEN SOCIETY

APPLICATION FOR EMPLOYMENT

PLEASE NOTE:

An electronic version of this form can be found at The form should be completed using black ink. Please do not attach your curriculum vitae. The information in this form will be treated as confidential.

TO BE COMPLETED BY APPLICANT

Surname:
Forenames:
Post applied for: / Job reference:
The Camden Society in an equal opportunity employer and as such welcomes applications from all communities.

External Job Application Form 02.11Page 1 of 7

GENERAL

Address:
Home Phone No: / Mobile Phone No:
Work Phone No: / Email Address:
Gender: / Male Female
Are you subject to any conditions relating to your employment in this country such as a work permit? / Yes No
If yes please give details:
Where did you hear about this vacancy?
Do you have a current full driving licence? / Yes No
Do you have a D1 (minibus) driving licence? / Yes No

EDUCATION

Schools from age 11

Name and location of School / Date left
(Month / Year) / Qualifications Obtained (level and grade)

FURTHER / HIGHER EDUCATION

Name and Address of College / University / Start Date(Month / Year) / Length of Course / Full/Part Time / Course title / Qualifications obtained
(level and grade)

VOCATIONAL QUALIFICATIONS

Please indicate if you have the following vocational qualifications:
Qualification / Yes / No / Course title / Date of Qualification
Learning Disability Award Framework including induction and foundation levels
NVQ
Teaching and Assessment
First Aid
Food Hygiene
Manual Handling
Health and Safety at Work
Fire Safety
Risk Assessment
Other

TRAINING

Give details of relevant training you have completed in the last three years. Do not include any courses listed above.
Training Course / Date / Duration / Name and Address of Training Organisation

PRESENT AND PREVIOUS EMPLOYMENT

Give details of your employment history, paid or voluntary, including any periods of unemployment or care of a child/relative from the year you left school.
PLEASE DO NOT LEAVE ANY GAPS.
Employers Name and Address
(start with the most recent) / Date from (Month / Year) / Date to (Month / Year) / Occupation / Salary / Reason for leaving

SUPPORTING INFORMATION

Please use this space to describe how your skills and experience meet the criteria outlined in the person specification. You should describe any work or voluntary activities you have undertaken in the past in which you demonstrated these skills/abilities.
Please state below why you are interested in this position.

REFEREES

Please supply references to cover a 5 year period. One reference must be from your most recent employer. Your referee must be your manager and not a work colleague. School or college leavers with no work history should give the names of tutors or head teachers.

Please ensure that your named referees are still in post and willing to provide a reference for you.
Reference 1 / Reference 2
Name: / Name:
Job Title: / Job Title:
Name of Company: / Name of Company:
Address of Company: / Address of Company:
Phone No: / Phone No:
Email: / Email:
Relationship to you (manager / lecturer etc) / Relationship to you (manager / lecturer etc)
If you are selected for interview can we contact your referees before the interview? / Yes No

CAMDEN SOCIETY WORK HISTORY

Have you previously worked for the Camden Society? If yes please give the dates of your employment and job title. / Yes No

CRIMINAL CONVICTIONS

Please state whether you have ever had a criminal conviction, caution, reprimand or warning. All posts (unless otherwise stated)are exempt from the Rehabilitation of Offenders Act 1974 Section 4(ii) (exceptions) Order 1975 and so ALL convictions however old must be disclosed. If you have answeredYes, please give dates and details below. / Yes No

DISABILITY

Do you consider yourself to be disabled? / Yes No
If yes please give details:
If you are invited to an interview, do you have any specific requirements related to your disability? / Yes No
If yes please give details:

INTERVIEWS

Are there any dates you will not be available for an interview?
When could you start if you were selected?

DECLARATION

The information on this form is accurate and if I am appointed will form part of my contract of employment. I understand that any incorrect information may lead to an offer of employment being withdrawn or to my dismissal should I have taken up an appointment. Any job offer is subject to the receipt of satisfactory references and Disclosure and Barring Service(formally known as the Criminal Record Bureau)check, Occupational Health Assessment and CQC registration if appropriate.
I also declare that I am not currently barred from working with vulnerable adults or children and I will inform The Camden Society immediately if I become barred.
Signed: / Date:
Return completed application form to: HROfficer, The Camden Society, 60 Holmes Road, LondonNW5 3AQor by email to

For official use only

Job Reference No: / Recruitment Coordinator:
Recruitment Panel:
Shortlisted: / Yes / No / Date: / Signed:
Interviewed: / Yes / No / Date: / Signed:
Post offered: / Yes / No / Date: / Signed:
Please make a note of any areas where the application form is incomplete :
Any additional information:

External Job Application Form 02.11Page 1 of 7