Position applied for Manager

PERSONAL DETAILS

First name / Surname
Address
Post code
Email / Telephone
Mobile
Date of birth
Nat Ins No.

Education

School, College, University / Qualification and Grade / Date obtained

Ongoing Professional Development

Qualification and Grade / Date obtained

Training

Please use the space below to give details of any training or non-qualification based development which is relevant to the post and supports your application.

Training Course / Course Details
(including length of course/nature of training)

EMPLOYMENT HISTORY

Employer/Organisation
(most recent first) / Position held and brief description of duties/responsibilities / Dates
From - To / Reasons for leaving
and final salary

MEDICAL HISTORY

Give a brief outline of any health problems or disabilities.
Do you hold a current, valid full driving licence? Yes / No
Do you have use of a car? Yes/ No

NAMES AND ADDRESSES OF TWO REFEREES

(One must be a previous employer and it is preferable if the other is someone who has knowledge of any work or volunteering previously done with children and young people.)

Employers’ Name
Address
Tel no.
Email:
Job title
Relationship to You: / Name
Address
Tel no.
Email:
Job title
Relationship to you:
Do you wish to be consulted before these referees are approached? Yes / No
Date you could start employment.

Because the work involves contact with children and young people you are required by the Rehabilitation of Offenders Act 1974 to declare all convictions, including spent convictions. Please sign one of the following statements as applicable.

1.I declare that I have no criminal convictionsfor offences involving children and/or young people and any unspent criminal convictions for any offence involving dishonesty, deception or assault against a person.

Signed: ……………………………………..………………

2.If short listed I will provide a list of all convictions in a separate sealed envelope to the Manager.

Signed: ……………………………………..………………

Having a conviction will not necessarily prevent you from working forWorcester Action for Youth (CIO).

I consent to a DBS check if this is required and agree to abide by the relevant policies and procedures. By signing this form, I agree to the details recorded here being held on computer by the Charity.

I understand that if any information I have provided is found to be untrue any offer may be withdrawn or any contract of Employment may be terminated.

Signed: ...... Date: ......

Additional information

Experience, Skills and Knowledge

Please use this section to demonstrate why you think you would be suitable for the post by reference to the job description and person specification.

How did you hear about the post?
Are you available for interview on5th July 2017?
Yes ….No
Declaration
Statement to be Signed by the Applicant
Please complete the following declaration and sign it in the appropriate place below. If returning by email, you will be requested to sign it at interview.
I agree that Worcester Action for Youth(CIO) can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998.
I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated.
Signed: Date:

Worcester Action for Youth (CIO)

Charity No: 1169888

Tel: (01905) 350550 email: