Confidential Job Application Form

Please complete in black ink

Use additional sheets where necessary

Position Applied For:

Personal Details

Title (e.g. Mr, Mrs, Ms, etc.):

Name:

Address (inc. postcode):

Email:

TelephoneDaytime:

Evenings:

Mobile:

Do you have the right to work in this country?

(including any necessary permit/visa)

(As part of our personnel procedures, we ask allstaff to provide proof of this prior to appointment)

Education from the age of 16

It is not necessary to include lists of subjects.

Dates / Place of study / Qualification

Professional Training and Qualifications

Dates / Place of study / Qualification

Work History, including voluntary work

Please continue on a separate sheet if necessary.

Dates / Organisation / Position / Responsibilities, reason for leaving,etc

Personal Statement

Please use the Job Description and Person Specs to explain why you feel you would be suitable for this position.

Please give us brief details of any interests/hobbies

Referees

Name, address and day time telephone number of two referees, one of which, if possible, should be your current or last employer. Please state your relationship to them. We will not contact referees without your permission.

1. / 2.

Additional Information

Please feel free to use an additional sheet to add any other information you feel might be relevant to your application.

Rehabilitation Of Offenders Act (1974)

The Police Act (1997)

As the Mary Frances Trust meets the requirements in respect of exempted convictions under the Rehabilitation of Offenders Act (1974), all applicants who are offered employment will be subject to a criminal record check from the Disclosure and Barring Service before appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions.

If you are invited for interview you will be asked to submit appropriate written details and dates in confidence of all criminal record information, including details and dates of “spent” convictions, caution, reprimands and final warnings. We will then be able to discuss with you whether such convictions may affect for suitability for this type of employment.

You do not need to disclose anything now – but if you would like to discuss any areas of concern, please contact us.

Declaration

I declare that the information given is to the best of my knowledge correct, and I understand that if appointed, this application form will become part of my contract of employment and any false information could lead to termination of employment.

Signed: ______

Date: ______

Data Protection

If appointed, this form will be held securely for the duration of your employment for the purposes of personnel management. In other circumstances, it will be destroyed after six months. If you would like us to destroy it earlier, please contact us.

Please forward your completed application form to:

John Anderton, Mary Frances Trust, 23 The Crescent, Leatherhead, Surrey KT22 8DY

Or email your completed form to:

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Mary Frances Trust is a Registered Charity No 1055113

Equal Opportunities Monitoring Form

We want to make sure that we are an equal opportunities employer in practice, which is why we want to monitor our recruitment procedures. We will separate this part of the form from the application form. It will not form part of the selection process.

Please tick the appropriate boxes:

Gender:Male Female Trans Prefer not to say

If you are undergoing the process of gender reassignment, please tick the box that applies to your future gender.

What age group do you belong to?

18-25 25-35 35-55 over 55 Prefer not to say

How would you describe your sexuality?

Heterosexual/Straight Gay man Gay woman/lesbian

Bisexual Other...... Prefer not to say

Do you consider that you have a disability?

Yes No I don’t know Prefer not to say

Do you have a disability as defined by the Disability Discrimination Act?

Yes No I don’t know Prefer not to say

Do you consider that you have a long-term health problem?

Yes No Prefer not to say

How would you describe your religion or belief?

My religion or belief is ………………………………………………………

I have no religion or beliefI prefer not to say

How would you describe your nationality?

British English Scottish Welsh Irish

Other (please describe) …………………………………

How would you describe your ethnic origin?

White White and Black Caribbean White and Black African

White and Asian

Any other Mixed background (please describe) ………………………………..

Asian Indian Pakistani Bangladeshi

Any other Asian background (please describe) …………………………………

Black Caribbean Black African

Any other Black background (please describe) …………………………………

Chinese

Any other ethnic group/background (please describe) ……………………………..

Prefer not to sayThank you for your help

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Mary Frances Trust is a Registered Charity No 1055113