* Please Complete for Contact Purposes. Please Note We Do Most of Our Communication Via Email

APPLICATION FORM Thank you for your interest in working with us. Please complete this form and return it to Laura Sercombe at Disability Challengers, Stoke Park, London Road, Guildford, Surrey GU1 1TU (if you use a large envelope you will need a large letter stamp) or email to [email protected]. To complete this application form on a computer, ‘tab’ through or click on the greyed out fields to add text. Use your mouse clicks to ‘check’ or ‘tick’ the boxes.

DISABILITY CHALLENGERS OFFICE USE ONLY

Date: Job Reference: Our Reference:

WHAT SORT OF WORK OF ARE YOU APPLYING FOR? What post are you applying for? Head of Finance Date

PERSONAL DETAILS Title (Miss/Mrs/Mr/ Forename: Surname: other) Please tick as Under 16 yrs 16-17 yrs Date of Birth if under 16 applicable 18 yrs & Over Nat Ins No

Postal address

Postcode Email address* Home Tel* Mobile* Other Tel

* Please complete for contact purposes. Please note we do most of our communication via email.

OTHER DETAILS Do you need a permit to work in the UK? YES NO

How did you find out about this vacancy? YES If yes, which Can you sign? NO language/method? Do you have a current First Aid YES When does the First Aid

Qualification? NO certificate expire? (dd/mm/yyyy) Do you hold a full driving licence? YES NO

HEALTH DECLARATION Do you know of any heath reasons which would YES prevent you from carrying out the duties intrinsic to this position as outlined in the job description? NO If you ticked ‘yes’, please give details and supply information of any adjustments you will need to make in order to carry out these duties.

OF 5 DISCLOSURE DECLARATION (This section must be completed) The position for which you are applying potentially involves unsupervised contact with children and is therefore subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means that you must disclose details of any convictions, bindover orders or police cautions, warnings or reprimands, including those which are considered “spent” under the terms of the Act. Please use the Disclosure Form at the end of this Application Form if this applies to you. This information will not be used to discriminate against you unfairly.

DO YOU NEED TO COMPLETE THE DISCLOSURE FORM? YES NO

EDUCATION AND QUALIFICATIONS (including current course if applicable) Date from Date to School/College/University Qualification & date if applicable

TRAINING/QUALIFICATIONS Date Course/Certificate Awarding body

OF 5 EMPLOYMENT HISTORY Give details of all previous employments, full and part time, paid or unpaid. List in order, STARTING WITH THE MOST RECENT FIRST. Explain any breaks in your employment history. Date from Date to Name & address of employer Job title and duties Salary and reason for leaving

SUPPORTING INFORMATION Please tell us why you are applying for this position together with any relevant experience .

OF 5 REFERENCES – Please note: Please supply FULL contact details of two (2) people who will provide a reference for you. Please do not supply both from the same place of work or education. ONE MUST BE FROM YOUR CURRENT OR MOST RECENT EMPLOYER OR, IF YOU ARE A FULL-TIME STUDENT, FROM YOUR PLACE OF EDUCATION. REFEREES MAY NOT BE MEMBERS OF YOUR FAMILY. REFEREE 1 Title (Miss, Mrs, Mr, other): Forename: Surname:

Relationship to you:

Organisation:

Postal address:

Postcode: Email: Daytime phone: May we contact this person now? YES NO REFEREE 2 Title (Miss, Mrs, Mr, other): Forename: Surname: Relationship to you: Organisation:

Postal address:

Postcode: Email: Daytime phone: May we contact this person now? YES NO

PLEASE READ AND SIGN THIS SECTION I confirm that the information which I have given is true and complete.* I consent for Disability Challengers to carry out the necessary Criminal Records Bureau and The Independent Safeguarding Authority - Vetting & Barring Scheme checks. I have read and understand the job description and The Disability Challengers Approach.

Signed: Date:

* Any false statements or omissions may result in dismissal.  If you have emailed this form to Disability Challengers, you will need to sign a printed version at interview.

OF 5 DISCLOSURE The position for which you are applying potentially involves significant contact with children and is therefore subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means that you must disclose details of any convictions, bindover orders or police cautions, warnings or reprimands, including those which are considered as spent under the terms of the Act. If applicable please complete the information below and return it with your application. This information will not be used to discriminate against you unfairly.

Title (Miss, Mrs, Mr, other): Forename: Surname:

Postal address: Postcode: Details about your criminal record: Date Nature of Offence Place offence occurred and Court Details of conviction, bindover which issued conviction if caution or warning applicable

I declare that the above information is accurate and complete. Signed: Date: Please be aware that any false statements or omissions may result in dismissal. If you have completed this form on a computer and emailed it to Challengers, you will need to sign a copy at interview.

EQUAL OPPORTUNITIES MONITORING Disability Challengers is committed to achieving a Play and Leisure service which provides equality of opportunity and freedom from unlawful or unfair discrimination. Our policy covers all aspects of our operations, including recruitment. Please complete this part of the form. This information will be used only in order to monitor our recruitment processes and prevent unfair discrimination on any grounds.

Forename: Surname: Male Female Disabled Non-Disabled How would you describe your ethnic background? White & Black Caribbean British Dual White & Black African White Irish heritage White and Asian Other White background Other Mixed background Indian Black Caribbean Asian or Pakistani Black or Black African Asian British Bangladeshi Black British Other Black background Other Asian background Other ethnic Please feel free to expand or specify: Chinese Chinese group or background It is our policy to employ the most suitable personnel and ensure equality of opportunity in the advancement of employees and not to discriminate against any person on the grounds of age, race, national origin, sex, marital status, disability or sexuality.

Disability Challengers, Stoke Park, Guildford, Surrey, GU1 1TU Tel: 01483 579 390 Registered Charity No. 1095134, A Charitable Company limited by guarantee No. 4300724