JOB APPLICATION FORM

By completing and submitting this application form and any related documents, you are consenting to us processing such data for personnel management and administrative purposes in accordance with Data Protection legislation. Please complete all sections 1-8.

Position applied for:

1. Personal detailsYour name

Address

Post code

TelephonesEmailDo you hold a full driving licence? Yes / NoAre you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) National? Yes / NoIf you have answered “no” above, you must answer these questions, if you have answered “yes”, please move on to section 2. Highly Skilled Migrant Programme/Tier 1 Post Graduate Doctors and

Dentists Indefinite Leave to remain/enter Tier 5 Temporary Workers Work Permit/Tier 2 Tier 5 Youth Mobility/ working

holiday visa Dependant / Spouse visa Refugee Clinical attachment visa Tier 4 student Other, please specify below Visitor

-----------------------------------------------------------Please supply details of any visa currently held:Visa No:

Start Date: (DD/MM/YY)

Expiry Date: (DD/MM/YY)

Details of any Restriction:

Does your visa have a condition restricting employment or occupation in the UK? Yes / No

2. ReferencesPlease provide the names and full contact details of the people who have agreed to supply references. References must include at least two positions with separate employers and, as a minimum, cover a period of three years employment and/or training history, where this is possible.

Referees will be required to comment on your competence, personal qualities and suitability for the post. This may be your line/department manager, or someone in a position of responsibility for any work experience or placement undertaken. If you are a student or trainee this should include a teacher/tutor at your education institution.

If you have not been in employment for a considerable amount of time but have had previous employment, then you should seek one reference from your last known employer and a personal reference from a person of standing within your community i.e. doctor, solicitor, MP etc. Where it is genuinely not possible to obtain references from any of the sources outlined above, then you must provide contact details of two personal acquaintances who would be willing to give a reference. Personal acquaintances must not be related to you, or have any financial arrangement with you.

Referees may be approached prior to interview, unless you indicate otherwise below.

Name:

Position:

Organisation:

Address:

Telephone:

Email:

May we contact this referee before interview?YES / NO

Name:

Position:

Organisation:

Address:

Telephone:

Email:

May we contact this referee before interview?YES / NO

3. ExperiencePresent or most recent employment

Job title

Employer

Address

Date appointed

Duties and achievements

Reason for seeking other employmentPresent salary or fee incomeNotice period required

4. Previous employment Please provide additional details on a separate sheet if necessaryEmployer name and address

Dates

Job title, main duties and achievements

Reason for leaving

Employer name and address

Dates

Job title, main duties and achievements

Reason for leaving

Employer name

and address

Dates

Job title, main duties and achievements

Reason for leaving

5. Education, qualifications and trainingPlease list your educational details including qualifications gained, and any relevant professional training undertaken

EducationPlease add additional rows if necessaryWhen Where Qualifications gained

TrainingPlease add additional rows if necessaryWhen Where Qualifications gained

6. Supporting informationMaking reference to the job description and person specification, please tell us why you think you are particularly suited to this job, and what special talents and insights you can bring to it. Use extra sheets if necessary.

7. Rehabilitation of Offenders Act 1974The post you are applying for is exempt from the provisions of the above Act. You are, therefore, not entitled to withhold any information about convictions you may have had including any ‘spent’ convictions. Any such information will be kept in strict confidence and used only in consideration of your suitability for the position for which you are applying. In the event of employment, any failure to disclose such convictions may result in disciplinary action or dismissal.

Do you have anything to disclose? Yes No

Details of offence and outcome

8. DeclarationI declare that the details given here are correct to the best of my knowledge and belief, and that I may be required to provide documentary evidence to substantiate certain this information. I understand that giving false information will disqualify me from being appointed or, if appointed, may result in my dismissal.

Name Date

When completed please return this form to:

ManagerSpace 2 Be Me Howard de Walden Centre Bluett Street MaidstoneME14 2UG

Or email to

fiona@space2beme.org.uk