Staff Application Form

Post Applied for:

Thank you for requesting an application form for this vacancy. Please complete the application as fully as possible. An attached C.V. will be welcome, but only as a supplement to the information on the application form.

Personal Details

Surname: / Address:
Post Code:
Forenames:
Tel no (Home):
Tel no (Work): / May we contact you at work? Yes/No
Tel no (Mobile): / Email address:
Previous Surname(s): / National insurance number:
DISABILITY DISCRIMINATION ACT 1995
If you require any special arrangements to be made to assist you if invited for interview, please let us know in advance of the interview.
Do you have the right to work in the UK? Yes/No
Note: the organisation will require proof of this right before an offer of employment can be confirmed – e.g. Birth certificate and/or any other appropriate document required to confirm your right to work in the UK as required by the Asylum and Immigration Act 1996
Are you related to or do you have a close personal friendship with any member of WMRSASC staff or Management Committee?
If yes, please state relationship:
Contact details for next of kin:
How did you hear about this vacancy?
How soon could you take up the post if offered it?

If appointed, the information provided on this form will be held in your records and will be used by WMRSASC to support payroll provisions and to contact your next of kin if necessary.

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Education, Training and Qualifications

Please give dates and details of all training and qualifications that you hold:

Dates Attended / Qualification obtained / Level of qualification / Provided by / Duration of course
Current membership of Professional Organisations (please give details):
Do you possess a full current UK driving licence? (please tick) / Yes / No
Do you have regular access to a vehicle? (please tick) / Yes / No

References

Please give details of two people who are able and willing to comment on your suitability for this job (email contact preferred). If you are, or have been employed, one should be your present or most recent employer.

Name / Name
Address / Address
Email address: / Email address:
Tel: / Tel:
Relationship to you, e.g. manager / Relationship to you, e.g. manager
Do you wish to be consulted before this referee is approached? Yes/No / Do you wish to be consulted before this referee is approached? Yes/No
Please provide details below if you have been convicted of a criminal offence or been the subject of a conditional discharge or probation order. Past criminal proceedings are not necessarily an obstacle to taking up a post. This occurs only where the offence/s is/are deemed relevant. All employees will be subject to a DBS check.

Present Employment

Name and address of current employer:
Position: / Salary: / Start date:
Main duties/responsibilities:
Reason for leaving/planning to leave: / Notice period required:

Previous Employment and Voluntary Experience (please continue on a separate sheet if necessary)

Position: / Start date: / End date:
Name and address of employer:
Main duties/responsibilities:
Reason for leaving:
Position: / Start date: / End date:
Name and address of employer:
Main duties/responsibilities:
Reason for leaving:
Position: / Start date: / End date:
Name and address of employer:
Main duties/responsibilities:
Reason for leaving:
Position: / Start date: / End date:
Name and address of employer:
Main duties/responsibilities:
Reason for leaving:

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Previous Experience

Please give a brief description (not more than 800 words) of your previous relevant work and life experience to demonstrate why you think you would be suitable for the post by reference to the job description and person specification (and by giving examples and case studies).
(Please continue on a separate sheet if necessary)

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Reason for Application

Please give your reasons for wanting to apply for this position with WMRSASC (not more than 500 words)
(Please continue on a separate sheet if necessary)

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Declaration

I declare that the information given in this application is correct and complete.

I understand that documentation associated with the process of appointment to this post will be held by WMRSASC for two years. I understand that if my application is successful, it will be held for the duration of my appointment. I agree that documentation generated during this appointment round may be accessed by anyone carrying out an audit of, or on behalf of WMRSASC or anyone acting on their behalf, insofar as is necessary to ensure a fair appointment process.

Under the terms of the Data Protection Act 1998, I agree that the information given in the application and monitoring forms may be processed to provide management information for appointment and equal opportunities monitoring purposes.

Signed: / Date:

You may be disqualified if you have made false statements or failed to disclose any information, which has been requested on this form. If this is discovered after you have been appointed, it may lead to dismissal or disciplinary action.

It is the policy of the WMRSASC to appoint staff solely on the basis of individual merit regardless of marital status, ethnic origin, colour, race, disability, sexual orientation, religious beliefs or age.

Recruitment and selection decisions will be based on objective selection criteria, ie job description and specifications of the skill, experience, qualifications and personal characteristics required to perform the work to the necessary standard.

Please email your completed application form to:

Or send to:

WMRSASC

PO Box 240

Worcester

WR1 2LF

Electronic submissions will be accepted if submitted by midnight on the closing date.

Please note we will not acknowledge the receipt of any applications.

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