APPLICATION FORM APPLICATIONS MUST BE TYPED Please note that pages will automatically extend on to the next page if necessary. The layout of this form may not be changed and your details must be typed into the boxes provided.
Post applied for: Reference Number:
Surname: First name(s):
Previous surname(s):
Address: Contact telephone number(s) and convenient time for us to contact you:
Email Address:
Current or most recent employment
Job title:
Full or part time position:
Dates employed:
Current or most recent salary:
Reason for leaving (if applicable):
Notice required (if applicable):
Employer’s name and address:
Key responsibilities of current post:
Page 1 of 7 Other than current/most recent employment. In date order, most recent first. Full Full employment history employment history must be provided.
From / to Title & key duties Employer’s name and Full or part Reason for (Month of the post address time position leaving And Year)
Please note this section will automatically extend on to the next page if necessary
All work must be included. Please give full details of any time gaps not indicated above. Your application may be rejected if you do not provide an explanation to any time gaps.
Page 2 of 7 Education and Qualifications Secondary education
From / to Examinations taken and (Month Name of school(s) qualifications obtained And Year)
Education and Qualifications Further and higher education
From / to Name of & type of institution attended Examinations taken and (Month (college, university, etc) qualifications obtained And Year)
Professional Qualifications and Membership
Awarding body - Level / grade of Date obtained Registration No. qualifications membership
Training Courses Attended Those relevant to the post
From To Details of training, including organising body
Full Valid Driving Licence Yes No Access to a motor vehicle Yes No
Experience and relevant skills
The job description and person specification detail areas of knowledge, experience and skills required, some of which are essential for the post. Please demonstrate in this section how you meet the requirements as detailed within the person specification. C.V.’s will not be accepted.
Please note this section will automatically extend on to the next page if necessary
Page 3 of 7 References
Please mark the box if you do not wish us to approach the referees below prior to interview. We require reference details that cover the last 5 years of your career history. NYAS reserves the right to contact any of your previous employers. Two referees are required as a minimum and referees should not be a relative or family member.
Name: Name:
Name of organisation / company you know this person Name of organisation / company you know this person from: from:
In what capacity do you know the referee?: In what capacity do you know the referee?:
Address: Address:
Telephone no.: Telephone no.:
E-mail: E-mail:
Fax no.: Fax no.:
Name: Name:
Name of organisation / company you know this person Name of organisation / company you know this person from: from:
In what capacity do you know the referee?: In what capacity do you know the referee?:
Address: Address:
Telephone no.: Telephone no.:
E-mail: E-mail:
Fax no.: Fax no.:
Name: Name:
Name of organisation / company you know this person Name of organisation / company you know this person from: from:
In what capacity do you know the referee?: In what capacity do you know the referee?:
Address: Address:
Telephone no.: Telephone no.:
E-mail: E-mail:
Fax no.: Fax no.:
Page 4 of 7 Asylum and Immigration Act 1996
National Insurance Number: A document showing your NI number, birth certificate or other proof of your entitlement to work in the UK will be required at interview. Only original documents (not copies) are acceptable.
Rehabilitation of Offenders 1975
Because of the nature of the job for which you are applying, this post is exempt from the provisions of the Rehabilitation of Offenders Act (Exemption Order) 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the revision of the Act.
Have you ever been convicted for any criminal offence or ever received a Police caution?
If “Yes” to the above, please give details of the offence(s), date(s) and where convicted or cautioned:
Disclosure of Relationship
I certify to the best of my knowledge and belief I am not related to any advocate or employee of NYAS
I declare that I am related to the following advocate or employee of NYAS
Name: Position:
Relationship:
Potential Conflict of Interest
You must declare if either you or a relative or family member carries out any work for the local authority or local service provider that may potentially bring about a conflict of interest.
Please find NYAS Values attached
Please complete and return the separate Equal Opportunities Monitoring Form
Page 5 of 7 I declare that the information which I have provided in this form is true and complete. I understand that, if it is subsequently discovered that any statement is false or misleading, I will be dismissed from my commitment to NYAS.
Signed: Date:
All posts are subject to satisfactory references and DBS (CRB) Enhanced Check.
Please indicate where you saw the position advertised
Newspaper or specialist magazine (please specify name)
NYAS Website
Other (please specify)
NYAS Tower House Tower Road Birkenhead Wirral, CH41 1FF Telephone 0151 649 8700 Facsimile 0151 649 8701 DX 17887 Birkenhead E-mail [email protected] Website www.nyas.net
Page 6 of 7 NYAS CORE VALUES
To achieve our mission and work towards our stated aims our approach to equality, diversity, and inclusion is based on the following core values:
Fairness – we will work to ensure that we promote equality, diversity and inclusion and do not discriminate against any of our service users, staff, volunteers or stakeholders.
Respect – we will encourage a workplace and service culture which is constructive, where everyone is valued for their contribution and their voice is heard. We will value all our service users, staff, volunteers and stakeholders as equal participants, treat them with dignity, and listen and be constructive in all our dealings with them.
Integrity – we will work to ensure that all our practices are transparent, open to change and honest and we will maintain confidentiality where appropriate.
Expertise and Excellence – we will ensure the highest professional competency and value mix that is optimistic, positive and able to contribute to all those we work with to enable them to reach their full potential.
Empowerment – we will work with individuals to enable them to fulfil their potential and maximise their ability to advocate for themselves.
Accountable we will take responsibility for what we do, acknowledge our mistakes and be accountable to stakeholders.
Independence we speak up on behalf of children, young people and vulnerable adults and use our independence to ensure their rights are upheld.
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