Balance Mission

“Through delivering excellent services, leading by example and influencing policy decisions, Balance will break down the barriers that prevent vulnerable people achieving their life goals.”

Application Form

Please use black font colour as this formwill be photocopied

Position Applying for

Name

Personal Details

Qualifications

Driving Licence UK

Mobile

Telephone Home

Telephone Business

Address

Email Address

National Insurance Number

First Name

Title

QualificationsPlease give details of all your qualifications, including professional qualifications. Proof of relevant professional qualifications/ status will be required before an appointment is made.

Qualifications

Establishment name

Year of Qualification

Other relevant training courses completed

Organising body and title

Brief description of course content

Year

Details of last or current employment

Employers Name

Job Title

Date To

Date From

Briefly describe your current/most recent position, highlighting skills, duties and responsibilities, or experience relevant to the post which you are applying.

Employer’s Address

Reason for Leaving

Salary and Benefits (If any)

Details of all previous employment (including voluntary, holiday, home-based, part time work). Please provide full contact details of previous employment in the care or education sectors.

Please detail any gaps in employment that are longer than two months in this section.

Dates of employment (Month & Year)

Employer’s full name and address

Job Title, Salary & brief description

Reason for Leaving

Supporting Statement

Using the job description as a guide, please summarise how you meet the requirements for the post. Please use examples to illustrate how you meet the person specification and why you are best suited to this position. Continue on a separate sheet if required

References – one reference must be from your previous employer.

Name

Name

How long have they known you?

Position

Position

Company Name

Email

Telephone

Address

In what capacity does the person know you?

How long have they known you?

Company Name

Email

Telephone

Address

In what capacity does the person know you?

The Rehabilitation of Offenders Act (Exemptions) Order 1975 applies to this post.

This means that you must disclose ALL criminal convictions (including those defined as spent under the Rehabilitation of Offenders Act), cautions, reprimands, final warnings, motor offences and any other information that may have a bearing on your suitability for the post, such as if your suitability to work with children or vulnerable adults has ever been questioned.

Failure to disclose any convictions / reprimands / cautions / final warnings or any other relevant information, may disqualify you from employment or result in your later dismissal. The Act does not provide any means of enforcing a person’s right not to be refused employment.

Date

Nature of convictions / reprimands / cautions / final warnings / other relevant information: (Please include dates)

Do you have any outstanding cases waiting to be heard?

No Yes – give date (if known) and details:

Have you ever been barred from working with children/young people/vulnerable adults

YesNo

Have you ever been dismissed from any previous employment?

Yes No

If yes, please give details ______________________________________________________________

______________________________________________________________

Do you consider yourself to have a disability?

YesNo

Please let us know if you require additional support during the application or interview process. We will always try to accommodate reasonable adjustments throughout our recruitment process.

The information on this form is correct. I understand that if I tell you something which I know is wrong or misleading, or I do not give you information which is relevant to my application, you may reject my application or, if I get the job, take disciplinary action, including dismissal.

Your signature: ................................................................. Date:............./............../.............

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