Where did you see this post advertised?

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Other (please state):

Work Experience
Please give the details of your present or most recent work experience
Name & Location of Employer:
Job Title:
Salary:
Notice Required:
Description of duties and responsibilities:
Previous work experience
Please list any previous employment, with the most recent first, including any voluntary positions
Name and location of employer / Job title and description of duties (state if voluntary) / Start and finish dates / Reason for leaving
Educational Achievements
Please give details of any educational achievements, starting with the most recent first
Place of study / Qualification or award (grade if applicable) / Date MM/YY
Training & Professional Qualifications
Have you undertaken any professional qualifications or training e.g. short-courses or on-the-job training? Please include details of the training provider and any other relevant details
Membership of Professional Bodies
Please give details of any professional bodies you have membership to.
References
Please give details of two persons who are prepared to act as your referees, one of whom would have knowledge of your current or most recent work experience if applicable.
Referee 1: / Referee 2:
Name: / Name:
Job title: / Job title:
Address: / Address:
Telephone: / Telephone:
Email: / Email:
May we contact this referee prior to interview? / Y / N / May we contact this referee prior to interview? / Y / N
Criminal Convictions
Do you have any unspent convictions? Yes / No
Your attention is drawn to the fact that under the Rehabilitation of Offenders Act 1974 you may be entitled to answer ‘no’ to this question even if you have, in the past, been subjected to criminal proceedings resulting in conviction(s). However, certain types of employment are excluded, under the Rehabilitation of Offenders Act 1974 (Exemptions) Order, 1975, from the protection of the Act. It is therefore, suggested that you take the appropriate advice if you are in any doubt as to the correct answers to give)
If ‘Yes’ please specify date of conviction, Court, nature of offence and sentence imposed:
Statement in Support of Application
Please use this section to support your application by describing any particular skills, knowledge and experience you have gained and how they will equip you for this post. Include any experience such as domestic, temporary, unpaid and voluntary work. You may attach additional sheets if more space is required.
Declaration
I, the undersigned, declare that the information on this form is correct to the best of my knowledge and that failure to disclose this information on providing incorrect information may lead to the termination of employment
Name: /
/ Date:

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