Positive Action for the Community

Positive Action for the Community

Application Form – Part 1

Please complete all sections of this application form, use additional sheets if necessary but ensure that additional sheets have reference to the question you are answering. Please do not enclose CVs.Please return both parts of the application form.

PAC, as an equal opportunity employer, intends that no job applicant or employee shall receive less favourable treatment because of his or her sex, age, marital status, race, colour, nationality, national origin, ethnic origin, faith, sexual orientation, or disability nor be disadvantaged by any other condition or requirement which cannot be shown to be justifiable.

Due to the nature of this work - all posts offered will be subject to disclosure & barring service (DBS) check

Post(s) applied for______

Forename(s)
/ ______
Surname / ______
Address / ______
______
______
______
Telephone Number / ______
Mobile Number / ______
Email / ______

National Insurance Number ______

Education and Qualifications

School / College

Name of
School/College / From / To / Qualifications Gained
(Please indicate level, awarding body, Subject(s),
Grades and Dates awarded)

Continue on separate sheet if necessary

Further Education / Higher Education

Name of College / University / From / To / Qualifications Gained
(Please indicate level, awarding body, Subject(s),
Grades and Dates awarded)

Continue on separate sheet if necessary

Additional qualifications / Courses

Name of Institution / From / To / Qualifications Gained
(Please indicate level, awarding body, Subject(s),
Grades and Dates awarded)

Continue on separate sheet if necessary

Employment Record

Present Post _

Hours per week? ______

Name and Address of Employer ______

______

______

Brief Description of duties undertaken

______

______

______

______

Starting Date in present post ______

May we contact this employer for a reference ahead of interview? Yes / No

If appointed on which date could you start? ______

Previous Employment

Dates / Position Held – brief description / Full time/Part Time / Name and Address of Employer / Reason for Leaving

Continue on separate sheet if necessary

References

References: Give below the details of 2 persons from whom references can be obtained – at leastone should be your present or most recent paid employer (or college/school tutor if no employment experience), the other should be a person who knows you in a professional capacity.

Current / previous employer / tutor
1.Name
/ Previous employer / tutor / professional
2. Name
Position/relationship to applicant
/ Position/relationship to applicant
Telephone / Telephone
Email / Email
Address
/ Address
May we contact prior to interview? / May contact prior to interview?

Do you consider yourself to have a disability? Yes/No

Please tell us if there are any ‘reasonable adjustments’ we can make to assist you in your application or with our recruitment process

Your attention is drawn to the fact that this post is covered under the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 and you should declare any convictions. If successful at interview, an Enhanced Criminal Record Certificate will be sought from the Criminal Records Bureau before confirmation of appointment. It is suggested that you take appropriate advice if you are in doubt as to the correct answer to give.

If you answer yes, please specify date of conviction, court, nature of offence and sentence imposed. We request that this information is sent under separate, confidential cover, to the Charity Manager and we guarantee that this information is only seen by those who need to see it as part of the recruitment process.

Have you ever been convicted of a criminal offence, including any driving offences? Yes/No

Do you hold a current Driving Licence? Yes/No

Do you have use of a car? Yes/No

Are you free to remain and take up employment in the UK?Yes/No

Declaration

All the information I have provided is true and correct. I understand that by providing false information my application will be declared void.

Signed ______

Date ______

Please email your application (parts 1 and 2) and monitoring form (part 3)to

or mark your envelope confidential and return completed applications to:

Business and Finance Manager, PAC, Hills House, Leeds Rd,

Nelson, BB9 8EL

Where did you see the advertisement for the post?

______

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