appform nocrb by z8OBCl

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									                                                                                                        CONFIDENTIAL


                                                                     APPLICATION FOR
                                                                        EMPLOYMENT
                                                      Please complete and return to:-
                                                      LEPRA Health in Action, 28 Middleborough, Colchester, Essex, CO1 1TG
                                                      or Email to Personnel@leprahealthinaction.org


1.   Position applied for: _______________________________________________________

     How did you learn of this vacancy? ___________________________________________

2.   PERSONAL DETAILS

     Surname: ___________________________                 Forename(s): ______________________________

     Address: __________________________________________________________________________

     __________________________________________________________________________________

     ________________________________________                         Post Code: ______________________

     Telephone:      Home: ________________________                   Mobile: _________________________

     Email: _____________________________________________________________________________

3.   OTHER INFORMATION

     Are you currently eligible for employment in the UK?                   YES / NO

     Please state what documentation you can provide in order to demonstrate this:




     If you are not currently eligible for employment in the UK, please state grounds (special skills, etc) on which we might
     apply for a permit on your behalf:




     Do you have a current driving licence?                  Provisional                 Full              No       
     Do you have use of a car?                               Yes                No       
     Do you have any current endorsements? (Give details)




4.   LANGUAGES
     Do you speak or read any foreign languages? YES / NO
     Please give details:
 5.    EDUCATION AND TRAINING - please give details relevant to this post and give some indication of your career
       objectives. Please continue on a separate sheet if necessary.




  6.    PROFESSIONAL MEMBERSHIPS AND QUALIFICATIONS:




 7.    EMPLOYMENT HISTORY (Please work backwards from your present/most recent employment. Continue on a
       separate sheet if necessary)

From              To               Employer and Type of business      Please give: your job title, a brief outline of
Month/Year        Month/Year                                          your duties and responsibilities and your
                                                                      reason for leaving




                                                                      Present/Final Salary:
From            To             Employer and Type of business   Please give: your job title, a brief outline of
Month/Year      Month/Year                                     your duties and responsibilities and your
                                                               reason for leaving


                                                               Present/Final Salary:




                                                               Present/Final Salary:




                                                               Present/Final Salary:




                                                               Present/Final Salary:
 8.   OTHER RELEVANT SKILLS AND COMPETENCIES - Please explain how you feel your skills and competencies
      match the needs of the post applied for. Please continue on a separate sheet if necessary.
9.     REASONS FOR APPLICATION / SUPPORTING INFORMATION - please give your reasons for applying for this
       post and any other information you think relevant; continue on a separate sheet if necessary.




10. REFERENCES - Please give three people, one of whom should be your present or most recent employer.
    No approach will be made before an offer has been made and accepted.

      Name                 Title/Position              Address           Telephone                   Relationship




11.    RECRUITMENT POLICY

       It is LEPRA’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of
       employees including promotion and training and not to discriminate against any person because of their sex,
       sexual orientation, religion, religious belief, marital status, age, race, ethnic origin or disability.
       I authorise LEPRA to obtain references to support this application once an offer has been made and accepted.
       Declaration: I confirm that the information given on this form is, to the best of my knowledge, true and complete.
       Any false statement may be sufficient cause for rejection or, if employed, dismissal.




       Signature:                                                        Date:
Equal Opportunities Monitoring.

LEPRA requires all its managers and other employees to operate its policy of equal opportunity and not to
discriminate against any person because of sex, sexual orientation, religion, religious belief, marital status, age,
race, ethnic origin or disability.

Please note that this form will be separated from your Application Form in the Personnel Department and used in
strictest confidence for monitoring purposes only. You are not obliged to complete this form.

Title                                 Full Name

Date of Birth                                           Male                   Female


Position applied for:

Ethnicity

I would describe myself as: (please mark with ‘Y' for one of the following)

ASIAN                                                   MIXED/DUAL HERITAGE
Bangladeshi                                             White & Asian
Chinese                                                 White & Black African
Indian                                                  White & Black Caribbean
Pakistani                                               Other Mixed Background
Vietnamese
Other Asian                                             WHITE
                                                        British
                                                        Irish
BLACK                                                   Other White
Caribbean
African                                                 OTHER
Other Black

Disability

Under the Disability Discrimination Act 1995, a person is considered to have a disability if he/she has a physical or
mental impairment which has sustained or long-term adverse effect on their ability to carry out normal day to day
activities.

Do you consider yourself to have a disability?            Yes                   No

If yes, please give brief details of your disability:




Signature                                                               Date

								
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