Lightburn Elderly Association Project (LEAP)

Application for the Post of: Please Clearly state which post/posts you are applying for :

1. PERSONAL DETAILS

SURNAME

First Name

Mr / Mrs / Miss / Ms

Address for Correspondence (please include postcode)

Daytime Telephone No. Mobile Telephone No.

Evening Telephone No. E mail Address.

Can we contact you at work? Yes / No

POST CODE:

(L.E.A.P.)LIGHTBURN ELDERLY

ASSOCIATIONPROJECT

APPLICATION FOR EMPLOYMENT

CONFIDENTIAL

PLEASE USE BLACK INK AND BLOCK LETTERS OR TYPESCRIPT AND RETURN TO THE ADDRESS SHOWN ON THE ACCOMPANYING LETTER WHEN COMPLETED.

2. PRESENT OR MOST RECENT EMPLOYMENT

Name of employer / organisation

Address

Job Title

Date Employed From To (if applicable)

Salary and other remuneration details

To whom immediately responsibleDescription of present role and responsibilities

Reason for leaving

Notice required

3. PREVIOUS WORK EXPERIENCE

Please start with most recent experience and account for any breaks in employment.You may continue on a separate sheet if necessary.

From To Organisation name and location Your Position Brief Description of duties and reason for leaving

4. EDUCATION AND TRAINING

Date School, College, University, etc Academic Qualifications

Other SkillsWhich computer and word processing packages are you experienced in using? Do you have any other skills or knowledge which may be useful, bearing in mind the job brief? (Do not repeat any points to be made at Question 5)

Are you currently studying? Yes / No (delete as applicable)

If Yes: College ………………………………………………….

Course …………………………………Completion Date ……………………..

Other qualifications e.g. Degree, HND, City & Guilds and/or Post Graduate

Date Course Title & College Qualifications

Professional qualifications

Are you a member of a professional organisation? Yes / No (delete as applicable)

If so, which? ………………………………………………………………………………………………

What is your membership level?

5. WHY ARE YOU APPLYING FOR THIS POST?

Please explain how your skills, experience and aptitudes make you suitable for this position and why this job is of interest to you. Please take time to refer to the Job Description and Person Specification and how your experience relates to them. You may continue on a separate sheet if necessary.

6. Attendance at work

Please list all absences from work through illness over the last 2 yearsNumber of days absent

Reason for absence Dates

From To

7. Are there any dates on which you would NOT be available for interview ?

PLEASE NOTE THAT THE INTERVIEWS FOR THESE POST WILL BE WEEK BEGINNING MONDAY 11TH JUNE 2018.

8. Do you have a disability which willrequire special provision at interview stage

Yes / No delete as applicable

If yes, please give details

9. Do you hold a full valid driving licence? Yes / No Do you own a car? Yes / No

Do You have any Penalty Points / Endorsements? Yes / No

If yes, please give details : __________________________________________________

10. Do you require a work permit to work in this Country? Yes / No

11. Are you known or related to any Director or employee of the Company? Yes /No

If yes, please give details

10. REFERENCES

Please give name and addresses of two referees, one of whom should be your present or if not in employment at present, your immediate past employer. References will be taken up for shortlisted candidates only.

Please tick the box provided if you do not wish us to contact your referee(s) without specific consent from you

Reference 1Name

Address

Tel. No.

Relationship to applicante.g. employer, tutor, friend

Reference 2Name

Address

Tel. No.

Relationship to applicant e.g. employer, tutor, friend

Important (please read carefully before signing declaration)

I certify that all statements given above by me on this form are true and correct to the best of my knowledge. I realise that if I am employed and it is found that such information and all other documents associated with the recruitment and selection process is false or that I have withheld information, I am liable to dismissal without notice.

Please sign (using initial and surname only) :

Date

Equal Opportunities Monitoring Form

The information provided on this form is not used to select applicants for jobs and all applicants are judged only on their ability to do the job for which they are applying. To check on the effectiveness of our Equal Opportunities Policy, we record the gender, racial origin, marital status and any disability of people who apply for jobs. To enable us to do this, we should be grateful if you would give the details about yourself which are requested below.

The information that you provide will be kept secure and separate from your job application form. It will not be made available to the initial selection panel. The information given will not be placed on your personnel file if you should be appointed.

If you do not wish to answer this questionnaire, your application will not be affected in any way.

1. Post applied for

2. Where did you see this post advertised ? ……………………………………

3. I am Male Female 4. Marital Status

Single Divorced Married Widowed Separated

5. Ethnic Origin

Do you consider yourself to be: Black White Mixed Other Please Specify ..................

Would you describe your ethnic origin as:

Asian African British/European Caribbean Irish South East Asian Other Please Specify..............

6. Disability

Do you have a disability? Yes No

Are you registered disabled? Yes No

7. Do you have any responsibility for Care? Yes No

If yes, please outline your responsibility for care i.e. Children, Elderly Dependents, Other Dependents with Disability :