Trafford Centre for Independent Living

Trafford Centre for Independent Living

Application form

Please return this formno later than

12:00 noon on Friday 8th March 2013.

This form can be returned via email at: or via post:Recruitment,Trafford CIL Marshall House Park Avenue SaleM33 6HE

As you type into the boxes, they will expand if you need more space.

Role applied for

Personal details

Title (Mr/Ms/Mrs/Miss etc)
Full Name
Any previous names
Address
Home Telephone
Mobile Telephone
Email
Do you hold a valid UK or EU passport?
If No, please state the basis of your entitlement to work in the UK
National Insurance Number
Languages spoken (other than English) - please indicate to what standard
Do you currently hold a CRB (Criminal Records Bureau) check issued within last 3 years?

Current/Most Recent Employment

Name/location of employer
Position
Main duties
Salary
Date started
Date left (if relevant)
Notice required (if still employed by this employer)

Previous Employment/Roles

Please give brief details of your previous employment history and work experience, either paid or voluntary

Dates

From To /

Employer and location

/ Job title and brief description

Education and training

Please give details of your education and training, starting with the most recent first

Date(s)

/

Education/Training

/

Qualification

Supporting information

Please read the Person Specification and Job Description and then describe any experience or qualities that you have that demonstrate how you meet the criteria.
(You may attach up to 3 additional sheets of supporting information)
Why are you interested in this position?

References

Please can you give the names and contact details of two referees. One must be your current or most recent employer and the second referee will, preferably, be another previous employer. Ideally they will have known you for more than 12 months.

Referee 1 / Referee 2
Title (Mr/Mrs/Ms, etc):
Full name:
Job Title:
Address:
Post Code:
Telephone Number:
E-mail address
How long haveyou known this person?
How do you know them (eg manager, friend)?
Can we contact them prior to interview?

Criminal records check

This post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975.

This means that you must tell us about convictions which for other purposes are `spent' under the provision of this Act, and so must disclose them below.

A criminal record will not necessarily exclude you from possible employment. Information given will be strictly confidential and will only be taken into account for the purpose of this application.

Have you ever been convicted of any criminal offence, whether ‘spent’ or ‘unspent’, as defined in the Rehabilitation of Offenders Act 1974 or do you have any charges pending? (Please tick or cross)

Yes / No

If yes, please give details

Access needs for the interview

What reasonable adjustments do you require for your interview(eg: large print materials, BSL interpreters)?

Access needs if successful with this application

What reasonable adjustments do you require if offered the post?

Where did you see this position advertised?

Trafford CIL Website
Trafford CIL Twitter Feed
Trafford CIL E-Bulletin
Other Website (please say which one)
Other (please say where)

Interview Availability

We have a tight schedule for this recruitment process. If you cannot come to any of the interview slots below, we may be unable to interview you.

Please tell us which slots you can come to, and please try to keep these datesfree.

Wednesday 20th March 2013 AM / Yes / No / Maybe
Wednesday 20th March 2013
PM / Yes / No / Maybe
Thursday 21st March 2013
AM / Yes / No / Maybe
Thursday 21st March 2013
PM / Yes / No / Maybe
Declaration
The answers that I have given are to the best of my knowledge a true statement. I understand that failure to disclose relevant information may lead to instant dismissal if I was to be offered employment.
Signature / Date

1