<p> JOB APPLICATION FORM</p><p>POSITION APPLIED FOR: </p><p>PERSONAL DETAILS</p><p>TITLE: EVENING TELEPHONE:</p><p>FORENAME(S): DAYTIME TELEPHONE:</p><p>SURNAME: MOBILE TELEPHONE:</p><p>ADDRESS NATIONAL INCLUDING INSURANCE POSTCODE: NUMBER:</p><p>E-MAIL ADDRESS:</p><p>CURRENT / MOST RECENT EMPLOYMENT</p><p>POSITION HELD:</p><p>NAME OF DATE APPOINTED: EMPLOYER:</p><p>ADDRESS OF DATE EMPLOYER: FINISHED:</p><p>SALARY:</p><p>TELEPHONE NOTICE REQUIRED: NUMBER:</p><p>REASON FOR LEAVING:</p><p>MAIN DUTIES AND KEY ACHIEVEMENTS: EMPLOYMENT HISTORY</p><p>Note: Please start with your most recent employment and work backwards EMPLOYER DATES JOB TITLE MAIN DUTIES REASON FOR (FROM – TO) LEAVING</p><p>Continue on a separate sheet if necessary</p><p>EDUCATION AND TRAINING</p><p>SECONDARY EDUCATION SCHOOLS ATTENDED FROM TO QUALIFICATIONS GAINED</p><p>FURTHER / HIGHER EDUCATION INSTITUTIONS ATTENDED FROM TO QUALIFICATIONS GAINED SPORTS QUALIFICATIONS (e.g. National Governing Body / sports coach UK courses) DATE DETAILS</p><p>OTHER RELEVANT QUALIFICATIONS / TRAINING DATE DETAILS</p><p>ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION</p><p>IMPORTANT NOTE: You should describe how you meet the requirements of the job description and person specification referring to current / previous employment, voluntary work and personal interests / hobbies. ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION continued</p><p>IMPORTANT NOTE: You should describe how you meet the requirements of the job description and person specification referring to current / previous employment, voluntary work and personal interests / hobbies. </p><p>Please continue on a separate sheet if necessary. ADDITIONAL INFORMATION</p><p>DO YOU HAVE ACCESS TO SUITABLE TRANSPORT FOR THIS POST? YES □ NO □ </p><p>DO YOU REQUIRE A WORK PERMIT TO WORK IN THE UK? YES □ NO □ </p><p>REFERENCES</p><p>Please give details of two referees. These must not be relatives and should include your current/most recent employer. </p><p>FIRST REFEREE SECOND REFEREE NAME: NAME:</p><p>POSITION: POSITION:</p><p>ADDRESS ADDRESS INCLUDING INCLUDING POSTCODE: POSTCODE:</p><p>TELEPHONE TELEPHONE NUMBER: NUMBER:</p><p>PLEASE DETAIL PLEASE DETAIL RELATIONSHIP TO RELATIONSHIP TO APPLICANT APPLICANT</p><p>CAN THIS PERSON CAN THIS PERSON BE CONTACTED YES □ NO □ BE CONTACTED YES □ NO □ PRIOR TO PRIOR TO INTERVIEW? INTERVIEW?</p><p>CAN THIS PERSON CAN THIS PERSON COMMENT ON YOUR YES NO COMMENT ON YOUR YES NO SUITABILITY TO □ □ SUITABILITY TO □ □ WORK WITH WORK WITH CHILDREN? CHILDREN? Do you consent to completing a Medical Clearance form, once employment has been offered and only if required? YES □ NO □</p><p>Have you enclosed your signed, completed self disclosure form with this application form? YES □ NO □</p><p>DECLARATION I certify that to the best of my knowledge the above details are correct. Signed: ______Date: ______Self-Disclosure Form</p><p>LIVING SPORT has a pro-active stance on protecting children and vulnerable adults from harm. To help us, we ask all job applicants to complete this confidential form. </p><p>1. Have you ever been convicted of a criminal offence or been the subject of a Caution or Bound Over Order? YES  NO  (please tick)</p><p>If YES, please state the nature and date(s) of these offence(s): </p><p>You are advised that under the provisions of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended by the Rehabilitation of Offenders Act 1974 (Amendment) 1986, you should declare all convictions, including spent convictions.</p><p>2. Have you ever been subject to any disciplinary action / sanctions relating to child abuse?</p><p>YES  NO  (please tick)</p><p>If YES, please give details: </p><p>3. Do you consent to LIVING SPORT carrying out a Criminal Records Bureau (CRB) Check on you; should you be offered a post? YES  NO  (please tick)</p><p>4. You are required to sign below to certify that:  You are not known to any Social Services / Social Care department as being an actual or potential risk to children;  You have not been disqualified or prohibited from fostering children or had any rights or powers in respect of any child vested in you assumed by a local authority;  No child has been ordered to be removed from your care;  If appointed you agree to: o abide by LIVING SPORT’S Child and Vulnerable Adult Protection Policy* o inform LIVING SPORT within 24 hours if you are arrested or investigated in connection with concerns about your behaviour towards children or vulnerable adults</p><p>Signed: Date: Name (please print): Any surname you were previously known by: Address: </p><p>Date of Birth: Place of Birth: We reserve the right to carry out checks to verify the information given on this form. If appointed, you may be subject to disciplinary action if any information is found to be false. * You can view this Policy on our website www.livingsport.co.uk.</p>