RESTRICTED WHEN COMPLETE WEST MERCIA PROBATION TRUST PLEASE DO NOT WRITE/TYPE IN THIS BOX – FOR OFFICE USE ONLY Candidate CAShre Ref wMar14 PERSONAL DETAILS FORM Please complete this application form in full and return to: Personnel Department, West Mercia Probation Trust, Head Office, Stourbank House, 90 Mill Street, Kidderminster, Worcs DY11 6XA or email to [email protected] Appendices other than continuation sheets will not be considered.

FOR COMPLETION BY CANDIDATE PLEASE INDICATE HERE THE POSITION YOU ARE APPLYING FOR Full time Case Administrator, Closing Job Title Thursday 17 April 2014 (12 noon) Shrewsbury date

Where did you see this post advertised?

PERSONAL DETAILS (BLOCK CAPITALS PLEASE) Forename(s) Surname

Address Preferred Title e.g. Mr/Mrs/Miss/Ms Home Telephone No. Post Code Mobile Telephone No. Current Full Driving Email Yes No Licence

REFERENCES Request for references will only be processed following an offer of appointment. The first reference should be your current or last employer, or course tutor. You must provide referee details that cover a minimum period of 5 years. Please use a continuation sheet if required. Name Address Occupation (please ensure that you provide the full address) /Position

Tel No: Email:

Tel No: Email:

January 2013 1 Candidate CAShrew Ref Mar14 PRESENT EMPLOYMENT DETAILS Name and Address of Present Employer Department/Section

Post Held

Date Appointed

Current Salary £ Other Allowances

Notice required by your employer

PREVIOUS EMPLOYMENT (Please list in order, most recent first and include any periods of voluntary work. Please give reason for any gaps in employment record) From To Name and Address of Employer Post Held Reason for Leaving

January 2013 2 RELEVANT QUALIFICATIONS AND/OR TRAINING (Please list in order, earliest first) Completion Date Description of Training/Course Awarding Body

January 2013 3 CRIMINAL CONVICTIONS

Rehabilitation of Offenders Act 1974 – The National Probation Service is exempt from the provisions of Section 4 of the above Act. This means that you must disclose ALL previous convictions, as an adult or juvenile, whether spent or not. You must also declare all cautions, bind overs, any road traffic offence, awards made by Courts Martial, or any pending proceedings. Failure to fulfil this requirement could result in any offer of employment being withdrawn. Please note that the existence of previous conviction(s), caution(s) or bind over(s) will not automatically disbar any candidate. Each case will be carefully considered on its individual merits.

Have you ever been convicted of a criminal offence, Yes No or been the subject of a bind over or caution? Do you have any charges pending? Yes No If the answer is YES to either of these questions, please give details, including the nature of offence(s) and date(s) of conviction(s), bind over(s) or caution(s).

January 2013 4 SUITABILITY FOR THIS POSITION

Please state how your skills and experience match the requirements of the job by referring to the job description and person specification. (max 750 words)

Word Count

January 2013 5 Head Office, Stourbank House, 90 Mill Street, Kidderminster, DY11 6XA Tel 01562 748375 Fax 01562 748407 Email [email protected] www.westmerciaprobation.org.uk

Serving Herefordshire Shropshire Telford & Wrekin Worcestershire

Diversity Monitoring Form Ref CAShrewMar14 This Service aims to be an equality of opportunities employer and staff are selected solely on merit irrespective of race, sex, sexual orientation, disability, age, or any condition or requirements which cannot be shown to be justified. All information which you disclose will be held under the principles of the Data Protection Act. This sheet will be detached from your application prior to short listing. Information will be treated as confidential information and may be held for up to one year for the purposes of monitoring equality of opportunity in our recruitment and selection procedure.

Personal Details: Gender: Male Female Date of Birth:

Sexual Orientation – Please tick against one of the following: Bisexual Heterosexual Gay Woman / Lesbian Asexual Gay Man Prefer not to say

Ethnic Origin – Please tick against one of the following: White Black or Black British British African Irish Caribbean Other Other Please specify………………………………... Please specify………………………………...

Mixed Chinese or other Ethnic Group White and Black Caribbean Chinese White and Black African Other White and Asian Please specify………………………………... Other Please specify………………………………...

Asian or British Asian Prefer not to say Indian Pakistani Bangladeshi Any other Asian background Please specify………………………………...

Religion or Belief – Please tick against one of the following: No Religion / Atheist Muslim Buddhist Sikh Christian Other Hindu Please specify………………………………... Jewish Prefer not to say

January 2013 6 Disability The Equality Act (2010) defines a disabled person as someone who has a physical or mental impairment which has a substantial and adverse long-term effect on his or her ability to carry out normal day to day activities. Conditions covered may include (but are not limited to) severe depression, dyslexia, diabetes, epilepsy and arthritis etc.

Do you consider yourself to be disabled within the meaning of the Equality Act (2010)? Please tick one of the following:

Yes No Prefer not to say

Please tick any of the following that apply to you. You may identify with more than one:

Hearing impairment Reduced physical capacity including difficulty with physical coordination Speech impairment Severe disfigurement Visual impairment (not corrected by glasses or contact lenses) Mental illness Reduced mobility Learning difficulties Progressive condition (e.g.cancer, muscular dystrophy, HIV, multiple sclerosis) Dyslexia Other Please specify………………………………......

Note: We guarantee to interview applicants with a disability (within the definition of the Act), who are deemed to meet the minimum criteria for the job. Declaration: I confirm that the information given in this application is complete and correct to the best of my knowledge. I understand that any appointment is subject to medical clearance and satisfactory references.

Signature: Date:

Please complete this application form in full and return to: Personnel Department, West Mercia Probation Trust, Head Office, Stourbank House, 90 Mill Street, Kidderminster, Worcs DY11 6XA or email to [email protected]

Appendices other than continuation sheets will not be considered.

January 2013 7