PEACE HUB

A project of Central England Quakers

Charity no.224571

PEACE HUB COORDINATOR

Application form

All information given on this form will be treated as confidential. Please complete in full. Please complete and return the enclosed Equal Opportunities Monitoring Form in the envelope provided.

Please email the completed form to with the subject “Peace Hub Coordinator job application”.

Application for the position of PEACE HUB COORDINATOR

Name………………………………………………………………………………………………………

Address……………………………………………………………………………………………………

Contact details…………………………………………………………………………………………..

If appointed when could you commence your employment?………………..……………

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PEACE HUB

A project of Central England Quakers

Charity no.224571

Education

From / To / Institution / Qualification / Subjects
TO ADD MORE ENTRIES, CLICK RIGHT BUTTON > INSERT > INSERT ROWS BELOW

rELEVANT Courses and training undertaken

Title / Provider / Duration / Date
TO ADD MORE ENTRIES, CLICK RIGHT BUTTON > INSERT > INSERT ROWS BELOW

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PEACE HUB

A project of Central England Quakers

Charity no.224571

Employment history, including voluntary work

(most recent first)

From / To / Name and address of employer / Position held and duties / Salary / Reason for leaving
TO ADD MORE ENTRIES, CLICK RIGHT BUTTON > INSERT > INSERT ROWS BELOW

Referees

Please give the name and occupation of two persons for reference. One of these should be your existing/most recent employer.

  1. Name
/ 2.Name
Address / Address
Telephone / Telephone
email / email
Occupation / Occupation

May we contact your current/most recent employer at this stage?

Yes/No

Application Statement

Please tell us why you have applied for this post, and add any further information in support of your application. Please refer to all the essential criteria in the person specification.

Type here

END OF STATEMENT

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PEACE HUB

A project of Central England Quakers

Charity no.224571

Criminal convictions

Do you have any unspent criminal convictions? Yes/No

Is there any reason why you should not work directly with children? Yes/No

How did you hear of this appointment?

…………………………………………………………………………………………………………………..

Personal declaration

I declare that the information I have given on this form is true and complete.

I understand that any willful misstatement or omission renders my contract null and void if employed.

I also understand that appointment is subject to receipt of satisfactory references, and, if required, medical examination.

Signed……………………………………………………Date………………………………

(A typed signature is acceptable)

Equal Opportunities Monitoring Form

Please complete in full, place in the envelope provided, and return with your completed Application Form.

This form will be stored separately from your completed application form. The information you give on it will be treated as confidential and will not be seen by the appointment panel.

The West Midlands Quaker Peace Education Project will provide equal opportunities to any employee or job applicant and will not discriminate directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origins, gender, sexual orientation, religion or belief, marital status, age or disability.

Post applied for:

PEACE HUB COORDINATOR

Gender………………………..

Do you have any disabilities? Yes/No

Ethnic origin

Choose one section from A to E,then type and “X” in the appropriate box to indicate your ethnic group

A. White / B. Mixed / C. Asian or Asian British
British / White and Black Caribbean / Indian
Irish / White and Black African / Pakistani
Other / White and Asian / Bangladeshi
Other / Other
D. Black or BlackBritish / E. Chinese
Caribbean / Chinese
African / Other
Other

Age range – please tick the appropriate box below

20-30 / 30-40 / 40-50 / 50-60 / 60+

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