Age Concern Wakefield District

PRIVATE & CONFIDENTIAL (Part A) Candidate No: ______AGE UK WAKEFIELD DISTRICT APPLICATION FOR EMPLOYMENT (Please complete this form in black ink or type)

Job Title: Support Worker (Activity Co-ordinator) - HM Prison Closing Date: 12 noon – Monday, 09 October 2017

PERSONAL DETAILS Forename(s): Surname:

Address: Telephone:

Mobile:

Email address: Postcode:

REFERENCES Please give below the names and addresses of two referees. One should be your current or most recent employer and neither should be a relative. 1. Name: 2. Name: Post held: Post held: Address: Address:

Postcode: Postcode: Telephone: Telephone: email: email: Relationship:

May this referee be contacted prior May this referee be contacted prior to interview? YES/NO to interview? YES/NO

CRIMINAL CONVICTIONS Have you ever been convicted of a criminal offence? YES/NO This post is excluded from the provisions of the Rehabilitation of Offenders Act 1974. If you have received any convictions in the criminal court, please enclose details in a separate envelope marked 'For the Attention of the Interview Panel'. It will only be opened if you are considered for the post, otherwise it will be returned to you unopened. Please note: Criminal Records Bureau checks may be made on successful candidates.

Do you require a work permit or special permission to work in the United Kingdom? YES/NO

DECLARATION Please sign to confirm that the information given in this Application Form is, to the best of your knowledge, true. Signed:______Date:______(Part B) Candidate No: ______

EDUCATION (Secondary Education only) School Exams passed with grade/levels

Further/Higher Education Qualifications taken with grade/levels CURRENT EMPLOYMENT DETAILS Name and address of Date employment Date employment Job Title employer/most recent employer commenced ended (if applicable)

Tel No: Brief description of duties:

Reason for leaving: Period of notice required by current employer:

EMPLOYMENT HISTORY AND/OR VOLUNTARY WORK Name & Address Job Title & Main Duties Dates OTHER COURSES/TRAINING etc

Details Year(s)

REASONS FOR APPLYING FOR THIS POST This is also an opportunity to draw attention to aspects of your career, interests, voluntary activities, etc relevant to this post and which may give additional weight to your application. Use an additional sheet of paper if necessary, up to a maximum of two sides of A4. TRANSPORT

Do you hold a current Driving Licence? YES/NO Do you have access to a car? YES/NO

Please return, marking your envelope ‘Confidential’, to:

Jan Hinton Office Manager Age UK Wakefield District 7 Bank Street Castleford WF10 1JD t 01977 552114 f 01977 518549 e [email protected]

Registered Charity No: 1096511 Company Limited by Guarantee No: 4512958 Registered in England and Wales

Age UK Wakefield District aims to be an Equality & Diversity Employer