Treatment Educationdrug Services

TREATMENT EDUCATIONDRUG SERVICES

ACROSS CWM TAF

APPLICATION FOR EMPLOYMENT

Please use black ink or type and complete all relevant sections.

PLEASE DO NOT SEND IN C.V.

Position Applied For:
DRINK WISE, AGE WELL - DIRECT ENGAGEMENT & SUPPORT (DES) PROJECT WORKER / Closing Date:
5.00pm Friday 2nd JUNE 2017

1. Personal Details

Last Name / Title (Mr / Ms / Mrs / Miss etc)
First Name (s)
Address
Postcode
Telephone (home) / Telephone (mobile)
Telephone (work) / please tick here if you do not want to be contacted at work 
Email Address
Welsh Speaker Yes No / National Insurance No.
Current Full Driving Licence Yes No / Car Owner Yes No
Do you require a work permit to take up employment in the U.K. under the terms of the Immigration & Asylum Act 1996? / Yes No
If yes, do you currently have the necessary documentation to enable you to work in the U.K. / Yes No
Are you aware of any medical conditions that may affect you in carrying out any of these duties specified in the job description – please specify below.

2. Employment History

Current/Most Recent Employer
Name and Address / Your Job Title
Start Date / Present / Leaving Salary
Brief description of duties / Leaving Date
Reason for leaving or wanting to leave
How many days sickness absence have you taken in the last 2 years?
Please explain the reasons for these absences
Previous Employer
Name and Address / Your Job Title
Start Date / Leaving Salary
Brief description of duties / Leaving Date
Reason for leaving

3. Previous Employment

(most recent first - include any voluntary work - please use continuation sheet if necessary and ensure that all periods are accounted for)

Start
Date / Finish
Date / Name & Address Of
Employer / Position
Held / Reason For Leaving

4. Please give details of any breaks in your work history

5. Professional Qualifications

Please give details of any professional qualifications or membership of professional bodies

Qualifications / Level / Issuing College / Authority / Date

6. Educational Qualifications

Please give details of educational qualifications and examinations passed

School / College / Subject / Grade / Date

7. Relevant Courses Attended

Continue on a separate sheet if necessary

Course Attended / Topics Covered / Date
Are you currently studying for any qualification? Yes No
If yes, please give details below

8. Personal Statement

Please refer to the person specification, where you will find the skills and experience required for this post. Please state how you feel you meet the criteria. Please do not just duplicate the person specification statements.

Please continue on an additional sheet if necessary

9. Have You Ever Been Convicted Of A Criminal Offence? Yes No

If yes, please give details, with dates and results. (See below)

Are you the subject of any criminal charge at present? Yes No

The Rehabilitation of Offenders Act 1974 entitles people who have been convicted of a criminal offence carrying a sentence of up to 24 years imprisonment and who have completed the appropriate period of rehabilitation to regard their conviction as “spent”. “Spent” convictions can then be regarded as never having occurred.
However, the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 exempts certain types of employment from the provisions of the Act and because the post for which you are applying is one such type of employment, you are not entitled to withhold information about convictions which for other purposes are “spent” under the provisions of the Act. You are advised that, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the employer.
Any information given will be completely confidential and will be considered in relation to any application for positions to which the Order applies.

10. IF SELECTED, WHEN COULD YOU TAKE UP EMPLOYMENT?

11. Please state if any special requirements are needed to enable you to attend for interview if you are selected.

12. Please give names of two people who will act as referee, one of whom must be your current or last employer.Can referees be contacted prior to interview? Yes No

Name / Name
Position/Relationship / Position/Relationship
Address
Postcode / Address
Postcode
Telephone including STD Codes / Telephone including STD Codes
Home / Home
Work / Work
Facsimile / Facsimile
Email / Email

DECLARATION

I confirm that the information I have given on this form is correct and complete and will form the basis on which any contract of employment is made.

I understand that misleading statements may be sufficient grounds for cancelling any agreements made.

Signed:Date:______

PLEASE RETURN TO:

Jean Harrington

TEDS

Engine House, Depot Road, Aberdare, CF44 8DL

Tel: (01685) 880090Fax: (01685) 880099

Closing date: 5.00 pm Friday 2nd June 2017

Interview date: TBC

TREATMENT EDUCATIONDRUG SERVICES

ACROSS CWM TAF

EQUAL OPPORTUNITIES MONITORING FORM

All applicants are invited to complete this form in order to help us develop and implement our Equal Opportunities Policy.

Your application will not be disadvantaged if you choose not to complete this.

The information will be used solely for monitoring purposes and will be treated as confidential and will be separated from your

application upon receipt.

1. Are youMaleFemale 

How would you describe your ethnic and cultural origins?
Do you consider that you have a physical disability?
YesNo 
What are your current domestic circumstances?

Single personParent

Single ParentCarer

Living with Partner

How did you find out about this vacancy?

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