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BLACKBURN CHILD CARE SOCIETY

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BLACKBURN CHILD CARE SOCIETY

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  • pg 1
									                                   Child Action Northwest

                         APPLICATION FOR EMPLOYMENT
PRIVATE AND CONFIDENTIAL

ALL SECTIONS OF THESE FORMS MUST BE COMPLETED IN APPLICANT'S OWN
HANDWRITING USING BLACK INK OR BALLPOINT. A CV AS AN ALTERNATIVE IS NOT
ACCEPTABLE

Position applied for:
(PLEASE ENSURE YOU STATE WHICH POST YOU ARE APPLYING FOR)
Notice period required for present employer:
A                                         PERSONAL DETAILS

Surname                                               Forename(s)


Any former Surname(s)


Address                                               Telephone Number:
                                                      (including STD Code)
……………………………………………………
                                                      Home:      ……………………………………….
……………………………………………………
                                                      Business: ……………………………………….
……………………………………………………
                                                      (Tick box if you do not want to be contacted at work)   
N I Number

B         EDUCATION AND QUALIFICATIONS

Please give details of examinations and results from age 11 yrs
      Name(s) and Address(es)                      Subject/Course                        Examination
       of School(s)/College(s)                     Studied & Level                       Result/Grade
C       FURTHER AND HIGHER EDUCATION

Please give details of all further and higher education since leaving school including training courses and
details of qualifications.
          University/College/                      Subjects Studied               Qualifications Obtained
           Institute Attended                     Type of Training




PROFESSIONAL ASSOCIATIONS: Please state whether you are a member of any technical or
professional association and, if so, which:

General Social Care Council Registered: Yes / No (please indicate – we will need to have a copy of
your certificate if you are employed by Child Action Northwest)
D              EMPLOYMENT HISTORY

Please list in reverse order all the organisations for which you have worked.
    Name(s) and Address(es) of                      Dates              Current       Reason for Leaving
  Employer(s) and Position(s) Held           From           To         Salary




                                                                                                      (cont)
D         EMPLOYMENT HISTORY (cont’d)

Please list in reverse order all the organisations for which you have worked.
    Name(s) and Address(es) of                      Dates              Current   Reason for Leaving
  Employer(s)and Position(s) held            From           To         Salary




PLEASE GIVE REASON FOR GAPS IN EMPLOYMENT:
      Date
From    To      Reason




PLEASE GIVE DETAILS OF ANY EXPERIENCE, SKILL OR ACHIEVEMENTS WHICH YOU FEEL
MAY BE RELEVANT IN YOUR APPLICATION FOR EMPLOYMENT.




                                                                                       (cont)
                                                     3
                                                                                      PERSONNEL/APPFORM
PLEASE GIVE DETAILS OF ANY EXPERIENCE, SKILL OR ACHIEVEMENTS WHICH YOU FEEL
MAY BE RELEVANT IN YOUR APPLICATION FOR EMPLOYMENT. (Continue on a separate sheet
if necessary)




                                                                               (cont)


                                        4
                                                                    PERSONNEL/APPFORM
E                         HEALTH

Are you in good health?                                                             Yes/No
Are you currently undergoing any treatment or attending any clinics?                Yes/No
If yes, please give further information


Are you a registered disabled person?                                               Yes/No

If yes, please give details of your disability.



Are you prepared to undergo a medical examination prior to employment?              Yes/No
F        SUPPLEMENTARY INFORMATION

Interests/Hobbies (Give details of pastimes, sports etc)




Offices held in social/sports clubs etc



Have you ever been convicted of a criminal offence?                                 Yes/No

Have you ever been cautioned for a criminal offence?                                Yes/No

If yes to the above, please refer to the enclosed sheet Rehabilitation of Offenders Act, 1974

COMMUNITY/VOLUNTEER EXPERIENCE
 Name and Address of Organisation                          Duties                          Duration




                                                      5
                                                                                           PERSONNEL/APPFORM
F         SUPPLEMENTARY INFORMATION
                    (cont)

Do you:                a) own a car?                              Yes/No

                       b) Have a current driving licence?          Provisional      Full  No 
                       c) have any current endorsements?          (give details)




Membership of professional organisation or trade union:




Do you need a work permit to work in the UK?                                         Yes/No

If yes, which of the following can you provide as proof of entitlement to work in Great Britain?


NI Card               P45/6             British or EEA passport            Other     (Please specify)



If offered this position will you continue to work in any other capacity? (give details)


G                    REFERENCES


1 PERSONAL REFERENCE                                  2 PROFESSIONAL REFERENCE
(must not be related to you)                          (Current employer. If not currently employed, give
                                                      details of most recent employer)

NAME …………………………………………..                               NAME …………………………………………..

ADDRESS ………………………………………                               ADDRESS ………………………………………

……………………………………………………                                  ……………………………………………………

……………………………………………………                                  ……………………………………………………

OCCUPATION …………………………………                              OCCUPATION …………………………………

TEL NO ………………………………………….                              TEL NO ………………………………………….

Please give your permission to take up references prior to Interview.
YES/NO (delete as appropriate)
RECRUITMENT POLICY

It is the Organisation’s policy to employ the best person for the vacancy and provide equal opportunity for
the advancement of employees including promotion and training and not to discriminate against any
person because of age, colour, disability, ethnic or national origin, marital status, nationality, race,
religious belief, sex, sexual orientation, or union membership status.

If shortlisted for this post, I agree to Child Action Northwest obtaining references to support this
application prior to interview and release the Organisation and referees from any liability caused by
giving and receiving information. If successful in this application, I agree to Child Action Northwest
applying for Criminal Records Bureau Clearance prior to my appointment being confirmed.

DECLARATION: I confirm that the information given on this form is, to the best of my
knowledge, true and complete. Any false statement or deliberate omissions may be sufficient cause
for rejection or, if already and employee, dismissal.

Signature ………………………………….                               Date …………………………………………..



How did you find out about the vacancy? ………………………………………………………………

For office use only
Driving licence checked                               Birth certificate           
Proof of qualifications                               Union membership            
References requested                                 References Received         
GP Report requested                                   GP Report Received          
CRB requested                                         CRB Received                
Interview date ……………………………… Successful Yes                      No 
Start date …………………………………… Interviewed by …………………………

Completed application form to be returned to:

                                             Mrs Sally Francis
                                             HR Administrator
                                             Child Action Northwest
                                             Whalley Road
                                             Wilpshire
                                             BLACKBURN
                                             BB1 9LL




                                                   7
                                                                                     PERSONNEL/APPFORM
MONITORING INFORMATION


Applicants are requested to tick the relevant boxes below to enable Child Action Northwest
to monitor its employment practice. Monitoring is recommended by the Codes of Practice
for the elimination of racial discrimination and discrimination on the grounds of gender,
marital status and age. This information is used for no other purpose and will be treated as
confidential.


Male                            Female


Ethnic Group

White                                                  Indian


Pakistani                                              Black Caribbean


Bangladeshi                                            Black Other           (please specify)


Chinese                                                Other                 (please specify)


National Insurance Number: ……………………………………………………


Do you consider yourself to have a disability?         Yes          No    
Are you registered disabled?                           Yes          No    
Describe your disability.      ……………………………………………………………………..


Please indicate where you saw the job advertisement.


Local paper                    (specify)              …………………………………………….

Job Centre/Library                           
Professional publication       (specify)              ……………………………………………

National paper                 (specify)              ……………………………………………

Other                          (specify)              ……………………………………………


Thank you for your co-operation.

                                                   8
                                                                                     PERSONNEL/APPFORM

								
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