Age Concern Central Lancashireageconcerncentrallancashire.org.uk › images › Jobs ›...

Guidance NotesPlease complete all 8 sections of the application form. If some parts are not relevant, write 'not applicable' or 'N/A' in that space.

Fill in the form as fully as possible. The information you give us in your application is the only information we will use in the short listing process. We cannot make any assumptions about your abilities and do not take account of any previous applications you have made.

Please do not send your CV with your application form.

We prefer applicants’ type onto this interactive form rather than handwrite it; however this does not exclude handwritten applications.

Application Form v1.0

Post applied for:

Section 1: Personal Details

Name:

Address:

Post Code:

Email:

Tel: Mobile:

Do you require a work permit? Yes No

Do you have:

(a) a current full driving licence? Yes No

(b) a car you can use for work? Yes No

Do you have any specific needs that we should consider to ensure that you have a fair interview e.g. access, communication needs etc.? Yes No

If yes please give details

How much notice would you need to give to your existing employer?

Section 2: References

Please give details of two people who would be willing to give you a reference. These should not be relatives or a current Age Concern Central Lancashire employee and one should be your current or most recent employer.

I am happy for references to be taken up:

Before interview Yes No After interview Yes No

Reference 1Name:

Position/ Title:

Address:

Post Code: Tel:

Email:

Occupation/relationship to you (if any):

Reference 2Name:

Position/ Title:

Address:

Post Code: Tel:

Email:

Occupation/relationship to you (if any):

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Section 3: Education/Training, Courses and Qualifications

Please include details of relevant education and training including short courses starting with the most recent first. Please give details of: Date from/ Date to/ Qualification obtained e.g. 12/03/12-14/03/12 First Aid at Work

Date from Date to Date qualification obtained Qualification obtained

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Section 4: Outside Interests and Hobbies, including voluntary work

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Section 5: Employment History

Please start with your current or most recent employer. Include details of any relevant voluntary work. Please detail Date from-to/ Employer/ Position/ Reason for leaving e.g. 01/02/99-03/04/05 NHS, Staff Nurse, Retired

Date from/ to Employer Position Reason for leaving

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Section 6: Further Information

Please refer closely to the job description and person specification, include your reasons for applying and how you feel your skills and experience are relevant.

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Section 7: Equal Opportunity Monitoring Form

Please complete the monitoring form below. The information on it will be used to monitor the Equal Opportunities Policy and ensure that it is working in practice. This information will be used only for monitoring purposes and will be treated in the strictest confidence. You may choose not to answer questions if you wish.

Date of Birth (dd/mm/yy)

Please complete the following statements:

Disability: Do you consider yourself to have a disability or long-term health condition that affects your day-to-day activities? Yes No

Gender/ Gender Identity:Male Female Transgender

Sexual Orientation:Heterosexual Bisexual Gay Lesbian Prefer not to state

Ethnic Origin: White British White Irish White European Dual Heritage

Chinese/ Chinese British Black/ Black British Asian/ Asian British

Other If other please state:

How did you first hear of Age Concern Central Lancashire i.e. friend, library, poster, leaflet, newspaper, job centre, Age Concern Website?

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Section 8: Rehabilitation of Offenders Act (1974) Declaration

The provision relating to non-disclosure of criminal convictions does not apply to certain positions. The post for which you are applying is included in the exempted type of employment under the Rehabilitation of Offenders Act (Exemptions) 1974 Order 1975, as amended. Therefore it is necessary for you to answer the following questions. The information will be kept in strict confidence and will only be used to consider Suitability for the post for which you are applying.Have you ever been convicted of any criminal offence? Yes No

If yes please give details of the conviction(s) and date(s)

(Maximum Characters (500)

Name:

Signature:

Submitting this form electronically is equal to my signature. If you are posting please add your signature

Date: (dd/mm/yy)

A criminal record will not necessarily debar you from employment with our organisation. However, if you are appointed and it is later discovered that you have not disclosed the information requested, you may be dismissed.

Please print off the completed application and post to: Head of Recruitment, Age Concern Central Lancashire, Arkwright House, Stoneygate, Preston, PR1 3XT

If you are posting your application form back to us and you do not affix the correct postage resulting in an underpayment we will not consider your job application

By Email If you would like to email your application form back to us please email to [email protected]

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