Rushmoor Borough Council

Rushmoor Healthy Living PRIVATE & CONFIDENTIAL Company Limited by Guarantee. Rushmoor Healthy Living welcomes applications from Registered in England & Wales Reg No 05164230 all sections of the community regardless of age, sex, marital status, race, colour, ethnic origin, nationality or Registered Charity No 1105381 disability Criminal records will be taken into account for recruitment purposes only when the conviction is relevant to the post applied for.

Application for post of: Employee Please state below where To be returned to: Chief Executive Officer you saw the Rushmoor Healthy Living advertisement for this 5th Floor, Rushmoor Business Centre Please write post Kingsmead “Private & Confidential” Farnborough on the envelope Hampshire GU14 7SR

PERSONAL DETAILS

Surname: ...... Mr/Mrs/Miss/Ms Address: ......

Forenames: ......

Telephone: ...... Home ......

...... Work Postcode: ......

...... Mobile E-mail: ...... SECONDARY EDUCATION Year Dates School/College Examinations Passed Level Grade Obtained

FURTHER EDUCATION Year College/University Qualifications Obtained Obtained

Qualifications being studied for: Examination Date

Membership of Professional or Technical Bodies:

RHL Appl Form V2 03/05/2018 EMPLOYMENT HISTORY Please give details of employment (paid or unpaid) covering the last 5 years or since leaving school/college, giving the most recent/current first:

Name & Address of Job Title From To Reason for Leaving Employer

TRAINING & DEVELOPMENT Please provide details of training and development relevant to the post you have applied for:

Course Title/Activity Organising Body Date and Duration

RHL Appl Form V2 03/05/2018 PRESENT DUTIES AND KEY RESPONSIBILITIES Please provide details of your duties and key responsibilities of your present/last post:

Present salary and grade/job title:

Reason for leaving present post: Notice required to terminate:

RELEVANT EXPERIENCE & PERSONAL SKILLS Please give a concise account telling us why you are suitable for the position you have applied for. In this section you may want to mention relevant experience which you may have gained inside or outside the work situation including IT skills. Please use the Person Specification as a guide

Please continue on separate sheet if necessary ADDITIONAL INTERESTS (such as membership of any clubs or leisure activities and hobbies where these may be of RHL Appl Form V2 03/05/2018 relevance to your application)

MISCELLANEOUS

Do you possess a full and clean driving licence? (only relevant if required by the post) YES/NO/N/A

Do you have access to transport which can be used for work purposes? YES/NO/N/A

Will you require a work permit for this employment? YES/NO

REFERENCES PLEASE SUPPLY THE NAME AND ADDRESS OF AT LEAST 2 REFEREES. YOUR REFERENCES SHOULD BE FROM SENIOR MANAGERS/SUPERVISORS AND COVER THE LAST 3 YEARS OF EMPLOYMENT, INCLUDING YOUR MOST RECENT EMPLOYER. YOU MUST NOT USE RELATIVES AS REFEREES. IF YOU ARE A STUDENT, PLEASE GIVE THE NAMES OF 2 LECTURERS/SUPERVISORS/TEACHERS.

NAME...... NAME......

POSITION...... POSITION......

ADDRESS...... ADDRESS......

......

POSTCODE...... POSTCODE......

TEL NO...... TEL NO......

May we approach if called for interview YES/NO May we approach if called for interview YES/NO

I declare that the information provided on this form is correct and understand that, if appointed, incorrect or misleading/incomplete information may result in dismissal. I also understand that any offer of appointment may be made subject to a satisfactory medical screening.

I acknowledge that jobs at RHL may require a Criminal Records Bureau (CRB) enhanced disclosure and confirm that I know of no reason why I should not work in contact with children and vulnerable adults.

Signature...... Date......

RHL Appl Form V2 03/05/2018 Asylum and Immigration Act 1996 Section 8

It is a criminal offence for an employer to employ those who do not have permission to live or to work in the United Kingdom.

Data Protection Act 1998

As part of the recruitment procedure we may collect and store sensitive personal data about you. We are required by law to obtain your consent to such data being recorded. It is our policy to store data relating to recruitment procedures for 12 months after the date on which it is submitted, for internal auditing purposes. Any information of this nature will be treated confidentially.

Sensitive personal data is defined as information relating to any of the following: racial or ethnic origin, political opinions, religious beliefs, trade union membership, health, sexuality or sex life, offences and/or convictions.

For the purposes of the Act the Data Controller is the Chief Executive, Rushmoor Healthy Living.

Information on this form will be confidential to those involved in the selection; interview and appointment process only and will then be held on your personnel file if you are appointed.

I declare that I understand the information given on this page and that I know of no reason why I should not be employed by RHL. I acknowledge that by signing this form I give my consent to sensitive personal information being recorded and stored.

Signature ______Date ______

RHL Appl Form V2 03/05/2018 Equal opportunities monitoring form (Completion of this form is optional)

Confidential

Please return this with your application form. It will be separated from your application before short-listing and will not be used as part of any selection process. It will be used for monitoring purposes only.

Post applied for ______

Surname/family name ______

First name/s ______

Gender Female / Male

Age ______

Ethnic group

Please indicate your ethnic group

White Mixed Asian or Asian Black or Black Chinese or Other British British Ethnic Group British White and Black Indian Black Caribbean Chinese Caribbean Irish Pakistani Black African Other Ethnic Group White and Black Other White African Bangladeshi Other Black

White and Asian Other Asian

Other Mixed

Disability

Do you have a disabilityYes ______No ______

Thank you for completing this form

RHL Appl Form V2 03/05/2018