WORCESTER ROOTS FOUNDATION
Application for the post of: Nature Trail Project Officer
Closing Date: 12pm Monday 10th March 2014
Please Note: Please complete clearly in black ink or type. Please do not send
CVs or Testimonials with this form.
When completed, this form should be returned to:
Natasha Giaquinto, Worcester Roots Foundation,
33 The Tything, Worcester WR1 1JL
PERSONAL INFORMATION.
Surname : ------First Name(s):------
Address :------Email: ------
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Telephone No: (Home)------(Mobile):------
PRESENT OR MOST RECENT EMPLOYMENT
Name of Employer : ------
Address : ------
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Telephone No : ------
Job Title : ------
Date Commenced : ------
Date Left (if applicable ) : ------
Salary : ------
Brief description of duties : ------
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PREVIOUS OCCUPATIONS :
(Please give brief details starting with the most recent first )
Organisation Job Title From To Reason for
& brief description (Month/Year) (Month/Year) leaving
of duties
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As Worcester Roots Foundation meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a criminal record check from Disclosure and Barring Service before the appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Having an ‘unspent’ conviction will not necessarily bar you from employment. This will depend on the circumstances and background to your offence. Any information provided will be discussed at the interview in order to assess job-related risks.
Have you ever been convicted of a criminal offence? YES / NO .
If yes, details may be required from you in strict confidence.
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CAR OWNER / DRIVER.
Do you posses a current full driving licence ? : YES / NO
Are you a car owner ?: YES / NO
If no, do you have access to a car ? : YES / NO
HEALTH.
Please state the number of working days lost through illness in the past 12 months:
------.
Have you had any period of serious illness in the past 2 years which has given rise to your being
absent from work for more than five consecutive days ? YES/NO
If yes , please give details :
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Please give details of any medical disability : ------
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Are you registered disabled ? : YES / NO
If yes, please give registration number : ------
EDUCATION (In chronological order from 14 years ) :
Name & Address Dates Exams Passed
of School
of University : ______
______
of other Training /Courses
______
Current membership of Professional Organisations (Grade & Date achieved )
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REFEREES : Name and Addresses of two referees.
At least one should be a present or most recent employer. Please indicate in what capacity you know
the referees and if they should not be approached before interview.
1. Name______2. Name______
Address______Address ______
______
______
______
Relationship ______Relationship ______
(Your referees will be contacted only if you are shortlisted for interview )
Please state where you saw this post advertised or how you heard about it.
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PUBLIC DUTIES :
Please give details of any public service duties you are required to perform (e.g. J.P,. Member of local
authority.
SUPPLEMENTARY INFORMATION.
This is an opportunity to draw attention to aspects of your career, interests, voluntary activities etc. relevant to this post and which may give additional weight to your application . Please state why you are interested in this post and what skills and experience you would bring to it. Please refer to the job description for further guidance of the skills required.
DECLARATION.
I confirm that the information given on this form is true and correct and understand that any deception could result in instant dismissal.
Signature of applicant ------Date : ------
If selected for interview candidates should bring with them their passport or birth certificate to satisfy relevant employment legislation.
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