Touchstone Application Form

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TouchstoneTouchstone House

2 4 Middleton Crescent

LeedsLS11 6JU

APPLICATION FORM

Please complete in type or block capitals in black ink.

(Please complete all sections of this form and do not submit a CV, as it will notbe considered)

APPLICATION FOR THE POST OF: .. REF NO: .

SURNAME OR FAMILY NAME: .

OTHER NAME: ......

HOME ADDRESS: ....

...

...

POSTCODE: .

TELEPHONE NUMBER (HOME): . (WORK): ..

MOBILE: EMAIL ADDRESS: .

May we contact you at work Yes No

Are you applying for this post on a job share basis?

Yes No


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Please answer the questions and do not submit a CV

1. PRESENT OR LAST POST (for applicants currently unemployed)

Post Held Department or section Date appointed Date Left

Name and Address of Employer:

.

.

.

Postcode:

Telephone Number: ..

Current Salary and Additions (andGrade if applicable):

Reasons for leaving:

Notice required to present Employer:

Can we contact you at work?

MAIN DUTIES AND RESPONSIBILITIES


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2. PREVIOUS EMPLOYMENTPlease list paid employment you have had, giving the most recent first (please attach an extra sheet if necessary):

Job Title DutiesEmployers Name and

AddressFrom To

Reasons forLeaving


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3. VOLUNTARY WORK / UNPAID

Organisation Post held/duties/regularity From To

4. EDUCATION AND TRAINING Please list any education or training you haveundertaken, together with qualifications obtained if any:

Subject/Qualification Place of Study Qualification/Gradeobtained

Year

4a. TRAINING COURSES ATTENDED Include in this section any relevant trainingcourses that you have attended or details of courses that you are currently undertaking,together with the date completed or to be completed.

Course title Training Provider Duration Year obtained

5. LIFE EXPERIENCEIs there anything else you have done that you wish to tell us about? This may includework experience, unemployment, caring for a child, relative or friend (please attach anextra page if necessary):


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6. PERSONAL STATEMENT

After reading the job description and personnel specification please complete this section.Please demonstrate how you meet the criteria set out in the Personnel Specification byusing relevant and specific examples. Invitation to interview for the position will depend onhow well you meet the set criteria.


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(Please attach an additional sheet if necessary)

7. Other Information

Do you hold a current, clean driving licence? Yes/ No* *delete as appropriateIf you have any endorsements, please give details:

Do you have the use of a car? Yes / No* *delete as appropriate

Are you related to any employee/Member of Touchstone or Board of Trustees?

If none, please tick none If yes, please complete the following details:

Name: Job title: Relationship:

Are you a United Kingdom (UK), or European Economic Area (EEA) National?

Yes No

Please confirm your current status in terms of entitlement to work in the UK:

British Citizen? Overseas National with permission to work in UK

Overseas National without permission to work in UK

8. Health RecordAre you aware of any health reasons which may impact on your ability to apply for thispost either at application or interview stage?

Yes No

If yes, please give advise us of any adjustments you may need making.

9. Rehabilitation of Offenders Act 1974This post is exempt from the provision of Sector 4 (2) of the Rehabilitation of Offenders Act1974. You are not entitled to withhold any information about convictions, including anycautions, which for the purposes are spent under the provisions of the Act. Anyinformation given will be completely confidential and will be considered only in relation toyour application for this post.

Have you at any time received, or have pending a court conviction (including any

cautions)?

Yes No


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If yes please give details: ..

Failure to disclose all convictions, including spent ones, will lead to your applicationform being disqualified, or if you are appointed to your dismissal. If the post you areapplying for involves substantial access to children and/or other specific vulnerablegroups, Touchstone will check with the CRB Disclosure Service for existence and contentof any criminal record if you are offered the post.

10. REFERENCES

Please remember to ask your referee/s for permission before you give their name.Please give the names, addresses and telephone numbers of two referees. If you are orhave been employed these should include your two most recent employers, your line

manager or someone in a position of responsibility who can comment on your workexperience, competence, personal qualities and suitability for the post.

If you are a student please provide contact details of a teacher at your school, collegeuniversity.

If you have not been in employment for a considerable amount of time but have previousemployment, then you should seek one reference from your last employer and personalreference, which you should not be related to. Personal references such as friends andrelatives are not acceptable.

1.Name

Email.

Address:.

.

Postcode.

Tel: .

Occupation:..

Relationship:..

2. .Name

Email:.

Address: .

.

Postcode:.

Tel: .

Occupation:..

Relationship:..

At what stage may we contact them? Before / After Interview / At Any Stage(please delete as appropriate)

I understand that appointment will be subject to the information given on this form beingcorrect and that canvassing or failure to disclose a relationship to a senior manager willdisqualify. To withhold, falsify or omit relevant information may lead to disciplinary action,including dismissal, in the case of a successful applicant.


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I have read this statement and confirm that all the information given by me is correct.

Signed: Date: ..

Touchstone Application Form

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