1St Place Sure Start Children and Parents Centre
Application form for Employment
(Please complete in black ink or type)
Post Applied for :Reference No :
Return to:
Human Resources1st Place Children & Parents’ Centre
Chumleigh Street, Burgess Park, London SE5 0RN
Email:
Tel: 020 7740 8070
Fax: 020 7703 1860
Your Details(please put in BLOCK CAPITALS)
TitleSurname
Forenames
DOB
Address:
Telephone Home
/ E-MailTelephone Work
Telephone Mobile
/ National Insurance No:References
Please give details of two people able to provide references relating to your experience and suitability to this post. The first referee should be your current or most recent employer. Friends or family may not be submitted for referees.
References will be collected prior to interviews as part of the safer recruitment process
Referee 1 / Referee 2Name / Name
Position / Position
Address / Address
Postcode / Postcode
Tel No / Fax: / Tel No / Fax:
Email / Email
Education and Training
Give details of Secondary Schools, Colleges, Universities or Institute of Further Education attended.
(You may be required to produce evidence of your qualification on appointment)
Name/Nature Of Establishment
(School, university, college etc.) / Qualifications Gained
(Give details, including dates of any educational Certificates, Professional or other qualifications and training with standard obtained, if applicable) / Period
(List dates starting with the most recent)
From / To
Full title of any professional body of which you are a member and state length of membership
Training Courses
(Please provide details by attaching a separate sheet listing any other relevant qualifications or courses attended (include non-certificate courses)
Experience, Skills & Interests
Please list any additional skills or training you feel is relevant to this post
Any Professional / Qualification Training currently in process?
Current or Last Employer
Job Title
Name of Employer
Address of Employer
/Post Code
Telephone Number
Dates employed from
/ ToReason for leaving:
Brief summary of duties:
Previous Employment History (for past 10 years starting with most recent)
Please use this section to outline in date order (starting with the most recent) details of your paid employment, volunteering activities and any other relevant activities. Where you have been employed by an agency outline the details of the agency as well as the placement(s). If there are any gaps in the information you give below please ensure you clearly identify the dates and provide information that clarifies the situation (e.g. education, travelling and unemployment). We reserve the right to approach any of your previous employers.
Position held & principle duties performed / Name & Address of Employer / From / To / Reason for leavingContinue on separate sheet if necessary
Please explain any gaps in your employment history and give reasonsStatement in Support
Please outline below why you are interested in this post, and describe how your skills, knowledge & experience are applicable (please address each item of the Person Specification in order, noting the number you are addressing).
Attach additional A4 sheet if necessary.
Are there any dates you would not be able to attend for interview?
Declaration
The details given on this application are correct to my knowledge and belief. I understand that my application may be rejected or that I may be dismissed for withholding relevant details or giving false information. By signing and returning this application form, I consent to the employer using and keeping information about me provided by me or by third parties such as referees relating to my application or future employment. Such information includes details relating to my health and to any criminal record.
This form was completed by:……………………………………………………. (Print Name)
Applicant Signature: …………………………………………..
Date: …………………………..
Positive about disabled people
1st Place is positive about employing people with disabilities and will make reasonable adjustments to enable full participation in the selection process and in employment with us. The following questions are designed to enable us to best support applicants with disabilities. If you are disabled you are guaranteed an interview if you meet the minimum requirements for the post. Note- You must say that you require this consideration on your statement in support, as this monitoring form is not included in the short listing process.
ADDITIONAL REQUIREMENTSDo you have any medical condition or disability that you believe we should be aware of:
(a) In relation to adjustments you may need us to make to enable you to participate in the recruitment process (interviews and tests?)
Yes No (if yes, please give details)
(b) In relation to your employment and for which you may require support, modifications, adjustments, or special equipment to assist you in carrying out the duties of this post?
Yes No (if yes, please give details)
Do You Require A Work Permit?
/ Yes / No If Yes, Please provide further details
EQUAL OPPORTUNITIES POLICY
1st Place Children and Parents’ Centre is committed to ensuring that no job applicant or employee receives less favourable treatment that others on grounds of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, sexual orientationor is disadvantaged by any conditions or requirements which cannot be shown to be justifiable.
MONITORING
In order to help us ensure that our Equal Opportunities policy is being carried out, we would be grateful if you could complete all parts of this page. This information is confidential and used solely by the Human Resources Department for monitoring purposes. It is not used as part of the selection process.
Please tick the description which you feel is the most appropriate
- Male
- Please choose ONE section from A to F below and then tick the most appropriate box (one box only)
A WHITE / B MIXED
British / / White & Black Caribbean /
Irish / / White & Black African /
Other (please write in) / / ______/ White & Asian /
Other (please write in) / / ______
C ASIAN OR ASIAN BRITISH
Indian / / D BLACK OR BLACK BRITISH
Pakistani / / Caribbean /
Bangladeshi / / African /
Other (please write in) / / ______/ Other (please write in) / / ______
E CHINESE / F ANY OTHER BACKGROUND
Chinese / / Any other background /
Other (please write in) / / ______/ Other (please write in) / / ______
Page 1 updated 11/07