<p> Octavia Foundation Application for Employment</p><p>Your application will not be considered for shortlisting if you do not complete all sections.</p><p>PostPost appliedapplied forfor ReferenceReference NumberNumber</p><p>WhereWhere diddid youyou hearhear aboutabout thisthis post?post? ClosingClosing DateDate</p><p>Personal Details</p><p>SurnameSurname FirstFirst NamesNames</p><p>PreviousPrevious NameName TitleTitle</p><p>AddressAddress</p><p>PostcodePostcode TelephoneTelephone</p><p>EmailEmail addressaddress MobileMobile</p><p>General </p><p>DateDate ofof birthbirth CountryCountry ofof birthbirth</p><p>Do Do you you requirerequire a a workwork permit? permit? Yes No </p><p>IfIf youyou havehave beenbeen grantedgranted thethe rightright toto workwork inin thethe UK,UK, pleaseplease givegive thethe namename ofof thethe permitpermit andand thethe expiryexpiry datedate belowbelow (Please(Please completecomplete thisthis questionquestion ifif youyou areare aa nonnon EUEU residentresident oror passportpassport holder)holder)</p><p>Do Do you you have have aa driving driving licence? licence? Yes No NationalityNationality</p><p>Are Are youyou related related to, to, or or do do you you live live with with any any of of our our employees?employees? Yes No</p><p>Are Are youyou a a tenant tenant of of Octavia, Octavia, oror are are you you related related to to or or live live with with Yes aa tenant?tenant? No</p><p>Are Are relatedrelated to, to, or or do do you you live live with with a a Board Board Member? Member? Yes No</p><p>IfIf youyou answeredanswered yesyes toto anyany ofof thethe aboveabove 33 questions,questions, pleaseplease givegive detailsdetails</p><p>HaveHave youyou beenbeen convictedconvicted ofof anyany criminalcriminal offenceoffence notnot yetyet spentspent underunder thethe Rehabilitation Rehabilitation ofof Offenders Offenders act? act? Yes No</p><p>IfIf yesyes pleaseplease givegive detailsdetails</p><p>Certain posts are exempt from this Act. If applicable you will be asked to complete a separate Criminal Records Bureau disclosure application form. Monitoring & Equal Opportunities Octavia Foundation works towards equality of opportunity in all aspects of its work. At Octavia our policy is to provide employment irrespective of race, colour, ethnic origin, religious belief, age, disability, marital status or sexuality. To ensure our policy is carried out, we monitor those who apply to us for jobs so that no group of applicants is considered less favourably than others. To help us to do this, please complete this form. The information you provide on this form will not affect your application. How would you describe your ethnic origin? Please mark appropriate box.</p><p>WhiteWhite BritishBritish BlackBlack AfricanAfrican</p><p>WhiteWhite IrishIrish BlackBlack OtherOther</p><p>WhiteWhite OtherOther OtherOther</p><p>MixedMixed WhiteWhite andand AsianAsian AsianAsian IndianIndian</p><p>MixedMixed WhiteWhite && BlackBlack CaribbeanCaribbean AsianAsian PakistaniPakistani</p><p>MixedMixed WhiteWhite && BlackBlack AfricanAfrican AsianAsian BangladeshiBangladeshi</p><p>MixedMixed OtherOther AsianAsian OtherOther</p><p>BlackBlack CaribbeanCaribbean</p><p>CurrentCurrent AgeAge MaleMale FemaleFemale TransgenderTransgender</p><p>DoDo youyou considerconsider yourselfyourself toto havehave aa disability?disability? Yes No</p><p>If yes, please ensure you notify the HR department if you feel any reasonable adjustments should be made to assist you in the recruitment process or job. Examples of a disability may include visual, hearing or speech impairments, mobility limitations, learning /cognitive impairments such as dyslexia, or mental health conditions. How would you describe your sexuality? Please mark appropriate box.</p><p>HeterosexualHeterosexual BisexualBisexual</p><p>HomosexualHomosexual RatherRather notnot saysay</p><p>What is your religion? Please mark the appropriate box.</p><p>BuddhistBuddhist MuslimMuslim</p><p>ChristianChristian SikhSikh</p><p>HinduHindu NoneNone</p><p>JewishJewish RatherRather notnot saysay</p><p>Data Protection Act By signing this application form, you consent to Octavia Housing obtaining, keeping, using and producing information relating to your application for a job with Octavia Housing for one year in order to consider whether to offer you any position, the terms on which to make such an offer, to answer any reasonable queries about the application and to monitor the recruitment process. Specific information to be used as follows: a) Your health – in order to consider whether you require any reasonable adjustments to be made during the application process or if offered a job to assist in the performance of your duties. b) Your ethnic origin – this is monitored to assess the effectiveness of our Equal Opportunities policy. The data provided on this form will be processed and stored with accordance to the Data Protection Act. Under the DPA the person that decides how information about information is used is know as the data controller. The Company Secretary is currently responsible for ensuring that we comply with our obligations under the Act. Work Experience Please include both paid employment and voluntary work experience. Continue on another sheet if necessary. The Association reserves the right to seek references from any previous employer, school, college or university. If you have not been in continuous employment or education throughout the last 2 years please supply details of a personal referee (other than a relative).</p><p>Present/most recent work experience</p><p>CompanyCompany NameName andand AddressAddress</p><p>TelephoneTelephone PostPost HeldHeld</p><p>DateDate fromfrom toto FinalFinal SalarySalary</p><p>Full Time Part Time Fixed Term Agency Voluntary StaffStaff categorycategory</p><p>NoticeNotice PeriodPeriod // AvailabilityAvailability forfor workwork</p><p>DutiesDuties andand responsibilitiesresponsibilities</p><p>ReasonReason forfor leavingleaving</p><p>Manager’sManager’s NameName</p><p>May we contact them before an offer of employment? May we contact them before an offer of employment? Yes No </p><p>Previous work experience</p><p>CompanyCompany NameName andand AddressAddress</p><p>TelephoneTelephone PostPost HeldHeld</p><p>DateDate fromfrom toto FinalFinal SalarySalary</p><p>Staff Staff category category Full Time Part Time Fixed Term Agency Voluntary </p><p>NoticeNotice PeriodPeriod // AvailabilityAvailability forfor workwork</p><p>DutiesDuties andand responsibilitiesresponsibilities</p><p>ReasonReason forfor leavingleaving</p><p>Manager’sManager’s NameName Previous work experience</p><p>CompanyCompany NameName andand AddressAddress</p><p>TelephoneTelephone PostPost HeldHeld</p><p>DateDate fromfrom toto FinalFinal SalarySalary</p><p>Staff category Staff category Full Time Part Time Fixed Term Agency Voluntary </p><p>NoticeNotice PeriodPeriod // AvailabilityAvailability forfor workwork</p><p>DutiesDuties andand responsibilitiesresponsibilities</p><p>ReasonReason forfor leavingleaving</p><p>Manager’sManager’s NameName</p><p>Previous Work Experience</p><p>CompanyCompany NameName andand AddressAddress</p><p>TelephoneTelephone PostPost HeldHeld</p><p>DateDate fromfrom toto FinalFinal SalarySalary</p><p>StaffStaff categorycategory Full Time Part Time Fixed Term Agency Voluntary </p><p>NoticeNotice PeriodPeriod // AvailabilityAvailability forfor workwork</p><p>DutiesDuties andand responsibilitiesresponsibilities</p><p>ReasonReason forfor leavingleaving</p><p>Manager’sManager’s NameName</p><p>Additional information required If there are any gaps in your experience or education please state below what you were doing during these periods. This should include any time spent being unemployed or at college. Please give your name and address of person such as college tutor or DSS office who can confirm this activity. Why are you interested in applying for this post?</p><p>PleasePlease explainexplain whywhy youyou decideddecided toto makemake youryour applicationapplication andand howhow youryour skills,skills, knowledge,knowledge, trainingtraining andand experience,experience, includingincluding unpaidunpaid activityactivity outsideoutside workwork makemake youyou suitablesuitable forfor thisthis post.post.</p><p>Please continue on a separate sheet if necessary, do not attach more than 2 additional sheets. Education</p><p>GeneralGeneral EducationEducation</p><p>SubjectSubject QualificationQualification GradeGrade YearYear obtainedobtained</p><p>FurtherFurther EducationEducation</p><p>DetailsDetails YearYear obtainedobtained</p><p>ProfessionalProfessional qualificationsqualifications andand membershipsmemberships</p><p>DetailsDetails ExamExam Date(s)Date(s)</p><p>Medical History</p><p>Yes No</p><p>DoDo youyou knowknow ofof anyany medicalmedical conditioncondition whichwhich youyou havehave whichwhich maymay affectaffect youryour abilityability toto carrycarry outout dutiesduties andand responsibilitiesresponsibilities forfor thethe postpost youyou areare applyingapplying for?for?</p><p>IfIf yes,yes, pleaseplease givegive detailsdetails</p><p>HowHow manymany daysdays sicknesssickness absenceabsence havehave youyou hadhad duringduring thethe lastlast 22 years?years?</p><p>Declaration</p><p>TheThe informationinformation II havehave givengiven inin thisthis applicationapplication is,is, toto thethe bestbest ofof mymy knowledge,knowledge, accurateaccurate andand complete.complete. II understandunderstand thatthat anyany subsequentsubsequent offeroffer ofof employmentemployment maymay bebe withdrawnwithdrawn oror mymy employmentemployment terminatedterminated ifif anyany ofof thisthis informationinformation isis foundfound toto havehave beenbeen falsified.falsified. II understandunderstand thatthat anyany offeroffer ofof employmentemployment willwill alsoalso bebe subjectsubject toto satisfactorysatisfactory references.references. II havehave alsoalso givengiven mymy consentconsent underunder thethe DataData ProtectionProtection ActAct 1998.1998.</p><p>Signed: Date: Please return your completed application form either by email or post. </p><p>Email: [email protected] </p><p>Or by post to: Octavia Housing, Emily House, 202/208 Kensal Road, London W10 5BN</p>