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CONFIDENTIAL

VIEWS: 5 PAGES: 4

									                 Application form downloaded from www.greatsocialcare.co.uk




                                  THE WILBERFORCE TRUST
CONFIDENTIAL
                                    APPLICATION FOR EMPLOYMENT

                                  POST APPLIED FOR:
                             LOCATION: YORK     TADCASTER
                    HOURS: FULL-TIME    PART-TIME   WAKING NIGHTS

                                            CLOSING DATE:




PERSONAL
How do you wish to be addressed? E.g. Mr/Miss/Ms/other
Surname:
Forename(s):
Address:
Post Code:
Preferred Contact Telephone No:
Email Address:

National Insurance No:
Do you need a work permit to work in the UK? Click to enter
If YES you will be required to produce evidence of your entitlement to work in the UK prior to appointment.
Have you a current driving licence? Click to enter
If Yes is the Licence Full or Provisional? Click to enter
Do you have any endorsements on your licence? Click to enter
 If YES give details:
Do you have Business Use on Your car insurance? Click to enter

EDUCATION
Schools Attended:                      Dates From/To:                         Qualifications attained
                                                                              (including grades)




Colleges/Universities Attended:        Dates From/To:                         Subjects taken and Qualifications
                                                                              Attained




Other Training/Membership of Professional Bodies/Apprentices/Special Courses etc. include dates where
appropriate:
EMPLOYMENT HISTORY (current or most recent employer first)
Please include temporary posts and work experience.
 FROM – TO         NAME & ADDRESS OF             JOB TITLE & DUTIES                              FINAL SALARY &
                        EMPLOYER                                                                   REASON FOR
                                                                                                    LEAVING




Notice required in current post:



GAPS IN EMPLOYMENT HISTORY
If Applicable, please state any reasons for gaps in your employment history


REFERENCES
Please note here the names, and full contact details of two persons from whom we may obtain references, one of which should
be your current or most recent employer. If you are not currently working in a care/support post but have previously worked
for 3 months or more in a post which involved work with children or vulnerable adults you must give that employer as a
referee, in addition to your current or most recent employer.
1.                                                                2.
Name:                                                            Name:
Address:                                                         Address:
Postcode:                                                        Postcode:
Contact Telephone Number:                                        Contact Telephone Number:
Email Address:                                                   Email Address:

Do you give permission for the referee to be                     Do you give permission for the referee to be
contacted prior to interview? Click to enter                     contacted prior to interview? Click to enter
Please note that if you do not give permission, this             Please note that if you do not give permission, this
will delay our ability to make a decision as regards             will delay our ability to make a decision as regards
your application.                                                your application.

Please note referees will be contacted for short listed candidates prior to interview unless stipulated
otherwise.




                                                             2
LEISURE
Please note here your leisure interests, sports, hobbies and other pastimes etc. including positions of responsibility held.


SPECIAL CONSIDERATIONS
Do you require the use of any of the following in order to support you through the interview process?

Wheelchair access
Hearing Loop
Written material in large print
Other – Please explain

REASONS FOR APPLICATION
Please detail here your specific reasons for this application, your main achievements to date, personal past experience you
consider relevant to your application. Applicants should read the job description and person specification carefully before
completing this section.




                                                                 3
CRIMINAL RECORDS BUREAU (CRB) – Disclosure Service

Under the C.R.B.’s Disclosure Service the Trust will require that your details are checked on the police
national computer.
The Trust has a commitment to uphold the strictest of confidentiality in respect of all information
provided via this source.

THE REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS ORDER 1975)

By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, the provisions of
Section 4.2 of the Rehabilitation of Offenders Act to not apply to any employment which is concerned
with the provision of health services and which is of such a kind as to enable the holder to have access to
persons in receipt of such services in the course of his/her normal duties. Your answer to the following
question must include any ‘spent’ convictions.

Have you ever been convicted of a criminal offence or received a Police caution? Click to enter

If YES please give details including your personal view of the relevance of the offence to your suitability
for employment.



DECLARATION (Please read this carefully before signing this application)

Are you related to or do you know any member of staff, Trustee or service user of the Wilberforce
Trust? Click to enter


I confirm that the above information is complete and correct and that any untrue or misleading
information will give the employer the right to reject my application, to withdraw any employment
contract offered or, if employed, dismiss without notice.

Signed:
If this form has been completed electronically you will be asked to sign this declaration if called for
interview.


Dated:


Where did you hear about this vacancy?

Please note you have been unsuccessful if you have not heard from us within 3 weeks of the closing date.

Please return to:
Chief Executive
The Wilberforce Trust
Wilberforce House, 49 North Moor Road, Huntington, York YO32 9QN

Or by email: enquiry@wilberforcetrust.org.uk




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