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A P P L I C A T I O N F O R M

APPLICATION FOR THE POSITION OF:______

ADVERT REFERENCE:______

1 . PERSONAL DETAILS Ap p l i c a n t ’ s L a s t N a m e /Family name______First Name(s)______

Ad d r e s s : ______

______Post code______

Home telephone number______Email address______

Work telephone number (if applicable)______Mobile number______

Do you require a work permit YES/NO (delete as appropriate) If yes, you will be required to provide details

National Insurance number you will be required to verify this.

2 . P l e a s e g i v e t h e n a m e s a n d a d d r e s s e s o f t w o r e f e r e e s . O n e s h o u l d b e y o u r p r e s e n t e m p l o y e r o r y o u r m o s t r e c e n t e m p l o y e r i f y o u a r e c u r r e n t l y u n e m p l o y e d . B o t h r e f e r e e s s h o u l d h a v e b e e n i n a p o s i t i o n o f r e s p o n s i b i l i t y w i t h i n t h e e m p l o y i n g o r g a n i s a t i o n ( s ) s e n i o r t o y o u . T h e y m u s t n o t b e r e l a t e d t o y o u , o r a f r i e n d . I f a s c h o o l / c o l l e g e l e a v e r p l e a s e g i v e d e t a i l s o f h e a d t e a c h e r / t u t o r . 1 S T R E F E R E E N a m e o f R e f e r e e :______

Organisation name:______Position held:______

O r g a n i s a t i o n Ad d r e s s : ______

______Post Code______

Telephone number______Email______

R e l a t i o n s h i p t o a p p l i c a n t : ______

May we contact this person before interview? YES/NO (delete as appropriate) 2 n d R E F E R E E N a m e o f R e f e r e e :______

Organisation name:______Position held:______

O r g a n i s a t i o n Ad d r e s s : ______

______Post Code______

Telephone number______Email______

R e l a t i o n s h i p t o a p p l i c a n t : ______

May we contact this person before interview? YES/NO (delete as appropriate)

REFERENCES WILL NOT BE ACCEPTED WITHOUT A COMPANY LETTERHEAD

R e g i s t e r e d C h a r i t y N o . 2 6 9 1 5 8 R e g i s t e r e d i n E n g l a n d N o . 1 1 9 7 4 7 8 Helping to shape integrated communities with care and support 3 . P R E V I O U S E X P E R I E N C E : ( O V E R T H E L A S T 5 Y E A R S )

Paid Employment (Permanent & Temporary) ~ S t a r t i n g w i t h y o u r m o s t r e c e n t w o r k f i r s t . If you currently hold more than one post give full details of all. Please include reasons for any gaps in your employment history.

D a t e s o f N a m e a n d Ad d r e s s Y o u r P o s i t i o n B r i e f O u t l i n e o f R e a s o n s E m p l o y m e n t . o f E m p l o y e r . a n d S a l a r y D u t i e s i n v o l v e d . F o r L e a v i n g

B ) V o l u n t a r y D a t e s N a m e a n d Ad d r e s s Y o u r P o s i t i o n B r i e f O u t l i n e o f D u t i e s

4 . Q U AL I F I C AT I O N S AN D T R AI N I N G P l e a s e i n c l u d e h e r e d e t a i l s o f a n y q u a l i f i c a t i o n s o r t r a i n i n g c o u r s e s t h a t y o u c o n s i d e r a r e r e l e v a n t t o t h e p o s t f o r w h i c h y o u h a v e a p p l i e d .

D a t e s O r g a n i s a t i o n r u n n i n g c o u r s e & t i t l e D e t a i l s o f c o n t e n t

Y O U M AY B E R E Q U I R E D T O P R O V I D E E V I D E N C E O F AN Y AC AD E M I C Q U AL I F I C AT I O N S S T AT E D . 5 . S K I L L S AN D E X P E R I E N C E

P l e a s e u s e t h i s p a g e t o d e s c r i b e w h y yo u c o n s i d e r yo u r s e l f s u i t a b l e f o r t h i s p o s t .

P l e a s e r e a d t h e a d v i c e n o t e s a n d a d d r e s s t h e p e r s o n s p e c i f i c a t i o n i n c o m p l e t i n g t h i s s e c t i o n . D r a w i n g u p o n y o u r e x p e r i e n c e , s k i l l s a n d q u a l i f i c a t i o n s e x p l a i n h o w y o u m e e t e a c h s e l e c t i o n c r i t e r i o n , a d d r e s s i n g e a c h o n e i n t u r n u s i n g a p p r o p r i a t e h e a d i n g s . T h e s h o r t l i s i t n g p a n e l n e e d s a s m u c h r e l e v a n t i n f o r m a t i o n a s y o u c a n p r o v i d e . 6 . H o w w o u l d yo u d e m o n s t r a t e yo u c o m m i t m e n t t o E q u a l O p p o r t u n i t i e s P o l i c y i n y o u r w o r k ?

7 . W h e n c o u l d yo u b e a v a i l a b l e f o r w o r k o r w h a t n o t i c e p e r i o d d o e s y o u r c u r r e n t e m p l o ye r r e q u i r e ?

8 . H a v e y o u e v e r b e e n c o n v i c t e d o f a c r i m i n a l o f f e n c e ? I f y e s , p l e a s e g i v e d e t a i l s o n a s e p a r a t e s h e e t . N . B . Al l c o n v i c t i o n s h a v e t o b e i d e n t i f i e d f o r t h i s t y p e o f w o r k a n d c a n n o t b e s p e n t . An e n h a n c e d C R B D i s c l o s u r e w i l l b e r e q u i r e d f o r a l l s t a f f .

9 . H o w m a n y s i c k a b s e n c e d a ys h a v e y o u h a d i n t h e p a s t 2 y e a r s ?

1 0 . D o y o u h a v e a n y s p e c i a l n e e d s i n o r d e r f o r yo u t o a t t e n d f o r , o r p a r t i c i p a t e i n , a n i n t e r v i e w ? I f s o , p l e a s e s p e c i f y.

1 1 . D o y o u h a v e a n y s p e c i a l n e e d s i n o r d e r f o r yo u t o a t t e n d f o r , o r p a r t i c i p a t e i n , a n i n t e r v i e w ? I f s o , p l e a s e s p e c i f y.

I declare that the information that I have provided is true and accurate, and in particular that I have not omitted any materials facts, which may have a bearing on my application. I understand that the offer of a contract of employment is conditional to the above. I accept that if I do not comply with the above any offer made to me may be withdrawn.

I accept that once I have commenced employment, Cyrenians will be entitled to terminate my contract without notice if there is, any untrue or inaccurate information, in or any material omissions from, my application or in any supporting documents submitted with it.

I give my consent to Cyrenians making such reasonable enquiries as it thinks fit in respect of the information and details given in this application.

Signature:______Date:______