Application form 8pp by nrk14057

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									      HEALTH & PERSONAL SOCIAL SERVICES


                 HPSS
                                             N O R T H E R N                I R E L A N D
                                             M A N A G E M E N T
                                             T R A I N I N G              S C H E M E




                          APPLICATION FORM

                            Instructions for completing application form
                                         PLEASE READ CAREFULLY

CSA is an equal opportunities employer. Any information provided by you on the application form will be
treated in the strictest confidence, however in the event of a complaint to a statutory body the Agency may
have to comply with legal direction and release this document.

1. Please ensure that you have completed all sections of the application form and the necessary information
   is recorded. Shortlisting will be based on the information contained within the relevant sections of the
   application form. You must fill in the relevant sections on the form, only when the sections on the form are
   complete should you continue on a separate sheet if you require more space.
   CVs WILL NOT BE ACCEPTED.

2. Canvassing will disqualify.

3. The application must be completed in black ink or if type script, size 12 font.

4. All applicants must provide their national insurance number. Failure to do so will result in their
   application form being regarded as incomplete.

5. All applications must provide two referees, one of whom should be your present/most recent employer or
   academic referee. Occupation and full address of referees must be specified. Relatives must not be
   used. References will be sought prior to final assessment stage.

6. All sections of the monitoring questionnaire must be completed. The information is treated as strictly
   private and confidential and is used for statistical purposes only. No panel member will have access to the
   questionnaire.

7 All applicants should sign and date their application. Failure to do so will result in the application being
  regarded as incomplete.

8. It is the responsibility of the applicant to ensure the completed form is returned by 4.30pm on the date of
   closing, to: Human Resource Directorate
                (Recruitment Section)
                Central Services Agency
                2 Franklin Street
                Belfast BT2 8DQ


            APPLICATIONS RECEIVED AFTER THIS DATE AND TIME CANNOT BE ACCEPTED
HPSS
                                GRADUATE ENTRY
                                                                                                PLEASE LEAVE BLANK
                                NORTHERN IRELAND
                                MANAGEMENT
                                TRAINING SCHEME
                                     APPLICATION FORM
 PLEASE COMPLETE THIS APPLICATION FORM LEGIBLY IN BLACK INK OR TYPESCRIPT FOR EASE OF COPYING


Please complete all parts of this form and return it to:

HUMAN RESOURCES DIRECTORATE
(RECRUITMENT SECTION)
                                                                      Please Note:-
CENTRAL SERVICES AGENCY                                               Please ensure you carefully read the instruction sheet
2 FRANKLIN STREET                                                     before completing the form.
BELFAST BT2 8DQ
                                                                      Completed forms must reach the Human Resources
Please sign and date your application and                             Directorate, Central Services Agency no later than 4.30 p.m.
check you have completed it fully and accurately.                     on Friday 20th January 2006.


     PART A: BIOGRAPHICAL INFORMATION

 Title: Dr, Mr, Mrs, Miss, Ms         Forename(s)                                       Surname


Address for correspondence:                                           Alternative address (if appropriate) :




Telephone:                                                            Telephone:

E-mail:

                                                                      Do you have access to a form of
Do you hold a full UK Driving Licence YES          NO                                                          YES      NO
                                                                      personal transport
 DO YOU NEED A WORK PERMIT TO TAKE UP PERMANENT EMPLOYMENT IN THE UK?                                  YES             NO

 SCHOOL EDUCATION – PLEASE DO NOT RECORD THE NAME OF YOUR SCHOOL/COLLEGE
 Examination details (starting with the most recent: A Level / O Level / GCSE or equivalent)
 EXAMINATIONS TAKEN                        GRADE           DATE   EXAMINATIONS TAKEN                           GRADE        DATE




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University/College Qualifications (starting with most recent)

University/College                                Course Title           Qualification          Dates                       Result
                                                                                           From          To      Expected Achieved




Professional/Vocational Qualifications

 Professional body                                 Qualification / Examinations taken       Dates             Grade of membership




Employment history to date (including current employer)
Include career breaks and give brief details. History should be continuous from leaving school.

 Employer                              Dates              Job Title, Grade     Type of work/main duties            Reasons
 (most recent first)               From      To             and Salary        full/part-time, voluntary etc       For Leaving




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  Our selection process is based around skills and behaviours which are essential for future leaders in the HPSS.
  Read the questions carefully and in each case give an example of how you have demonstrated these skills and behaviours.
  Your examples might be from your work, academic, family or social life.

        PART B: GENERAL INFORMATION

1. DRIVE AND DETERMINATION
Please tell us about an occasion which best demonstrates your drive and determination to overcome difficulties to achieve
something. Explain how you approached the situation and managed to overcome any obstacles.




2. TEAMWORKING
Please tell us about an occasion different to the example above, when you have worked as a member of a team. Describe your
personal contribution to the team and explain how this helped to achieve the team’s objectives.




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  3. CAREER CHOICE
  Please tell us how you arrived at your career choice and eliminated any alternatives.




  4. SUPPORTING INFORMATION
  Please use this space to give details of any leisure, voluntary activities or any other information you feel may support your
  application.




  DISABILITY

In accordance with the Disability Discrimination Act 1995, a disability is defined as: “a physical or mental impairment which has a
substantial and long term adverse effect on your ability to carry out normal day to day activities”.
Do you consider yourself to have a disability?                                          YES                   NO

If you have answered yes to this question, is there any reasonable adjustment which you believe is necessary for the Agency to
make to allow you to fulfil the requirements of the job for which you are applying?

.................................................................................................................................................................................................................

.................................................................................................................................................................................................................

Do you require any special arrangements to be made for your interview?

.................................................................................................................................................................................................................

.................................................................................................................................................................................................................

The final Assessment Centre may involve some physical activity. Are there any adjustments which we may have to make?

.................................................................................................................................................................................................................

.................................................................................................................................................................................................................
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              PART C: OTHER INFORMATION


MEDICAL HISTORY
Please give brief details and approximate dates of any periods of sickness during the past 2 years.

 REASON FOR SICKNESS                                                                                                               NUMBER OF DAYS ABSENT




  NATIONAL INSURANCE No.


   FROM WHAT SOURCE(S) DID YOU LEARN ABOUT THE NORTHERN IRELAND HPSS MANAGEMENT TRAINING SCHEME?

 ROGET                                                    *NATIONAL NEWSPAPER                                           MTS PRESENTATION
 CAREERS ADVISER                                          *LOCAL NEWSPAPER                                              WEBSITE CSA
 CAREERS FAIR                                             HPSS/NHS CONTACTS                                             WEBSITE BEECHES MANAGEMENT CENTRE


 OTHER: _____________________________________________________________________________________________________
 *Please specify date and name of publication/location : ________________________________________________________________

   REFERENCES – Please give the names of two referees (not relatives or family members).
                One of which should be your present/most recent employer or academic referee.


    NAME:                                                                                                  NAME:

    ADDRESS:                                                                                               ADDRESS:




    POSTCODE:                                                                                              POSTCODE:

    OCCUPATION:                                                                                            OCCUPATION:

 REFERENCES WILL BE REQUESTED PRIOR TO THE FINAL ASSESSMENT STAGE.


   Under the Rehabilitation of Offenders (Exceptions) Order Northern Ireland, 1978, the Northern Ireland Health and Social Services are
   included in the list of exempted employments. As such, any criminal conviction may never be regarded as spent and must be disclosed
   when applying for a post within the Health Service.
 IT IS NECESSARY THEREFORE TO ASK THE QUESTION:
 HAVE YOU EVER BEEN CONVICTED OF ANY CRIMINAL OFFENCE?                                                                           YES                         NO
 IF YES PLEASE GIVE DETAILS




 IT SHOULD BE NOTED THAT DISCLOSURE OF A CONVICTION DOES NOT NECESSARILY DEBAR ANY APPLICANT
 FROM OBTAINING EMPLOYMENT.

   I hereby confirm that the information given on this application is complete and correct and I understand that any untrue, incomplete
       or misleading information will give you, the employer, the right to terminate or withdraw any contract of employment offered.


SIGNATURE ..................................................................................................................... DATE .......................................................................

            PLEASE MAKE SURE YOU FILL IN THE EQUAL OPPORTUNITIES MONITORING FORM
                                     ON THE FACING PAGE
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                                                  APPLICANT REF. NO.

                                           CENTRAL SERVICES AGENCY
                                   EQUAL OPPORTUNITIES MONITORING


     NON COMPLETION OF THIS SECTION WILL RESULT IN YOUR APPLICATION BEING REJECTED


The Central Services Agency is committed to equality of opportunity for all job applicants regardless of
sex, marital status, disability, age, religious affiliation, political opinion or ethnic origin.

The Agency selects those suitable for employment and advancement solely on the basis of merit and
is also monitoring its activities to ensure that its equal opportunities policy is effectively implemented.

The application of equal opportunity in the Agency is being implemented on the basis of a comparison
of the sex, marital status, disability, ethnic origin and perceived religious affiliation of applicants. To
assist in this monitoring process it is necessary to ask you the following questions.


1.       SEX :               Male                           Female


2.       MARITAL STATUS : Single                                Married                       Other


3.       DATE OF BIRTH: .................................................


4.       RELIGIOUS AFFILIATION :
         I am a member of the Protestant community ...................................................

         I am a member of the Roman Catholic community ..........................................

         I am a member of neither the Protestant nor the Roman Catholic community



5.       ETHNIC ORIGIN
         01 Caribbean                                       02 African                               03 Chinese

         04 White                                           05 Bangladeshi                           06 Pakistani

         07 Indian                                          08 Black                                 09 Irish Traveller

         10 Other Ethnic Group (please describe) ............................................................................................


6.       DISABILITY
         In accordance with the Disability Discrimination Act 1995, a disability is defined as “a physical
         or mental impairment which has a substantial and long term adverse affect on your ability to
         carry out normal day to day activities”.

         Do you consider yourself to have a disability?                          Yes              No

Access to this information is strictly controlled and will not be available to those considering your application.
Monitoring will involve the use of statistical summaries information in which the identities of individuals will not
appear. The information will not be available for any purpose other than equal opportunities monitoring.
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