Application Form. Personal Details (please complete in BLOCK CAPITALS and in BLACK INK) Education (Secondary School)

Transcription

1 Application Form Post: HEALTHY HOME TECHNICIAN Personal Details (please complete in BLOCK CAPITALS and in BLACK INK) Home Address: Date of Birth: Tel. No. Home Tel. No. Work Mobile No. National Insurance No. Do you hold a current Driving License? Yes No Do you have a car that you would be prepared to use for work in exchange for an allowance? Yes No Education (Secondary School) Name of Establishment Qualifications obtained or to be taken Results (including grades) Date Obtained Further Education & Training (Please include all formal qualifications and any vocational training undertaken in the last five years) Course Details (where taken, organising body & details) Qualifications obtained (where applicable) 1

2 Education continued Membership of Professional Body: (include grade / status of membership) Present Employment (or most recent employment) Name & Address of Employer: Job Title: Salary (& grade if applicable): Date Appointed: Notice Required: Outline of Duties and Responsibilities: 2

3 Previous Employment (in date order, starting with the most recent first) Employer Position Held and Brief Description of Main Duties Reason for leaving Referees One of your referees must be an employment reference. If you choose not to give your present (or last) employer as a referee you should be able to provide a reason for this at interview. Please cross the box if you do not wish your referees to be approached without your prior permission (1) Designation: Address: (2) Designation: Address: Tel No. Tel No. 3

4 Experience / General Information In Support of Application Please give details of any past experience, skills, or tasks you have undertaken which you feel may be helpful to your application, giving examples where appropriate. Please attach additional sheets as necessary. (Refer to the Job Description and Person Specification for the post to help you address all the relevant points) 4

5 Many of the clients of Preston Care and Repair are extremely vulnerable. Throughout all aspects of our Service their needs and concerns are of paramount importance to us. We reserve the right to take all reasonable steps to ensure that the staff, contractors, and volunteers that we engage do not pose a risk to their health, safety, or welfare. We therefore ask that all applicants respond honestly to the following question. Any disclosure will not necessarily exclude you from selection, but we may wish to discuss the details with you in further detail. Rehabilitation of Offenders Act 1974 Have you been convicted of a criminal offence? If, please specify date of conviction, nature of offence and sentence imposed. (Any information you provide will be treated as strictly confidential and will be considered only in relation to your application) Disability Discrimination Act 1995 As an employer seeking to treat all sectors of the community fairly and equally we are striving to ensure that we are accessible to all. We will be able to address issues of accessibility, etc, if we are aware of any particular issues for applicants. We would be grateful therefore if you would respond to the following questions. Do you consider yourself to be disabled? If, please give details: Are there any arrangements that we would need to make to offer you a fair selection interview should you be short-listed for this vacancy? If, please give details (e.g. parking space, ground floor venue, sign language interpreter) Declaration I declare that the above information on this form is correct and understand that, if appointed, I will be liable to disciplinary action including dismissal and / or criminal action should I knowingly give false information. Signature: Date: Please return your completed application form to the Agency Director, Preston Care & Repair, The Annexe, St Paul s Road, Preston. PR1 1PX Preston Care and Repair may opt to keep completed application forms for a period of 6 to 12 months. Please tick the box if you do not wish us to keep your application form on file and contact you in the future with regards to other possible vacancies. 5