Application Form- Confidential

Please return this form to or complete in black ink and post to; Jan Hughes, Glasgow Children’s Hospital Charity, PSP House, 50 High Craighall Road, Glasgow G4 9UD.

Please do not send a CV. You MUST answer every question and state ‘Non Applicable’ if appropriate.

VACANCY DETAILS

Post applied for:
Where did you see this post advertised?

PERSONAL DETAILS

Surname:
Forename(s):
Forename known by: / Title:
Address:
Telephone number: / Home / Mobile / Work
Email Address:
Do you have a current full, clean driving license? YES / NO
Successful candidates that are essential car users will be asked to produce their full driving license.
Do you have your own car? YES / NO
Please detail any current endorsements on your driving license:
Issue / Date / Penalty / Expiry Date of Penalty
EMPLOYMENT HISTORY
Name of Current/Last Employer
Address of Employer
Post held / Start Date: End Date:
Brief description of your duties
Present salary/Finishing salary or rate of pay / Notice Required
Reason for Leaving / Reason for Pursuing New Employment
Previous employment: Please list all previous employment, starting with the most recent and continue on separate sheet if necessary:
Dates (from/to) / Employer / Job title / brief description of duties / Reason for leaving
RELEVANT VOLUNTARY EXPERIENCE, if any:
Experience / Organisation: / Dates (from/to):
RELEVANT PROFESSIONAL QUALIFCATIONS GAINED, if any:
Title of Professional Qualification / Organisation: / Dates (from/to):
PROFESSIONAL MEMBERSHIPS, if any: / Dates (from/to):
CONTINUOUS PROFESSIONAL DEVELOPMENT AND WORK RELATED TRAINING
Please list those most relevant to your application and most recently attended first.
Course Title / Date Attended
EDUCATION AND TRAINING, from secondary school to further education:
Dates (from/to) / Qualifications gained / training undertaken – please provide grades attained / Name of school, college etc
THE REHABILITATION OF OFFENDERS ACT 1974
The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, as amended, the order applies to all posts unless otherwise stated. You are required to complete the Criminal Record Declaration Form below.
A Disclosure Scotland Check will be undertaken for the successful candidate (s).
Do you have any criminal convictions? The role applied for is an exception under the order and accordingly you are not entitled to withhold details of any convictions which may otherwise be regarded as spent.
YES / NO
If ‘yes’ please provide details
GENERAL
Please give details of pastimes, sports etc.
Offices held in social/sports clubs, etc.
Public duties (JP, local councilor, etc) undertaken.
If offered this position will you continue to work in any other capacity?
PERMISSION TO WORK IN THE UK
Are there any restrictions to your residence in the UK that might affect your right to take up employment in the UK? YES / NO
If you are successful in your application would you require permission to work in the UK? YES / NO
REFERENCES: Please provide the names of two referees; ideallyone must be your current employer and the second from a previous employment. Should this not be possible then your second referee should befrom someone who has known you in a professional/official capacity. Friends/Family will NOT be accepted as referees. References will be sought if candidate is successful and Glasgow Children’s Hospital Charity are under no obligation to disclose to you any information provided by your referees.
Name (and post title if applicable) / Contact Details / Capacity in which he/she has known you
Organisation Name:
Organisation Address:
Telephone:
Email:
Organisation Name:
Organisation Address:
Telephone:
Email:
YOUR EXPERIENCE AND ABILITIES: Please use this space to comment on how your education, training and previous experience make you suitable for this post as outlined on the job description. Please also explain any gaps in your employment history.
Please start typing here and use as much space as you require.
Please tell us about a relationship that you have built/ developed with an organization, and how you maintain this relationship, maximizing its potential?
Declaration (Please read carefully)
I declare that all of the information that I have provided is true, to the best of my knowledge and belief and is complete. I understand that if it is subsequently discovered that any information I have provided is false or misleading, or that I have withheld relevant information, this will be sufficient cause for rejection, withdrawal of any offer of employment or, if employed, dismissal without notice or other disciplinary action.
I authorise the organisation to obtain references to support this application once an offer has been made and accepted and release the organisation and referees from any liability caused by giving and receiving information.
I consent to Glasgow Children’s Hospital Charity and others on its behalf, including its successors in title, retaining and processing any information that I provide for the purposes of recruitment and employment and in the exercise of the company’s legitimate interests. I consent to the sharing of information with other departments within the company.
Signature:
Date: