Personal Details (Complete This Section in Block Capitals)

EAST END RESPITE CARE GROUP

‘GEEZA BREAK’

APPLICATION FORM

PERSONAL DETAILS (COMPLETE THIS SECTION IN BLOCK CAPITALS)
Post Applied For:
Surname: / Firstname: / Date of Birth:
Address:
Postcode: / Do you hold a current full driving licence?
Yo N o
Does your licence have penalty points or endorsements?
Yo N o
If yes, please give details:
Home Telephone: / Business Telephone:
QUALIFICATIONS
SECONDARY SCHOOL QUALIFICATIONS
Qualification / Grade / Subject / Date / Qualification / Grade / Subject / Date
FURTHER & HIGHER EDUCATION QUALIFCATIONS
Name of Institute / College / Qualification / Subject / Date
PRESENT EMPLOYMENT (OR MOST RECENT EMPLOYMENT)
Name and address of Employer: / Job Title:
Date started: / Date left:
(if applicable)
Period of Notice: / Salary and other benefits: / Grade:
Main duties and responsibilities:
PREVIOUS EMPLOYMENT
List in order, with most recent first, and include any periods of unemployment.
Name and Address
of Employer / Job Title and
Main Responsibilities / Period of Employment
From To / Reason for leaving
ADDITIONAL INFORMATION
State any information which you feel is RELEVANT to your application. (e.g. training, personal qualities, achievements at work, non-work related or voluntary work experience). Use additional sheet if required.
REFERENCES / Please give the names of two referees who have knowledge of your work, one of whom should be your present employer. If you are currently not working one referee should be your last employer. Your referees must have known you for at least two years. Relatives and close family friends will not be accepted.
Name: / Name:
Occupation: / Occupation:
Address: / Address:
Post Code: / Post Code:
Telephone No. / Telephone No.
May we contact your present employer for a reference before any job offer is made to you? Y o N o
Please give full name and address of your GP.
Where did you hear about this post? Please specify.
Have you applied for employment with East End Respite Care Group previously?
Yes / No
If yes please specify the post(s) for which you have applied.
REHABILITATION OF OFFENDERS ACT 1974
All applicants called for an interview will be required to complete a health questionnaire and a Disclosure Scotland Form. This post is subject to the Rehabilitation Of Offenders Act 1974 (Exceptions) Order 1975 As Amended.
APPLICATION DECLARATION
I confirm to the best of my knowledge the foregoing information is correct. I understand that if I am selected to work with East End Respite Care Group and it becomes apparent that the information provided in this form is false disciplinary action may be taken against me, including dismissal from the post.
SIGNATURE: DATE:

Please return this form to: East End Respite Care Group

Academy House

1346 Shettleston Road

Glasgow

G32 9AT

East End Respite Care Group, Registered Scottish Charity SCO 19637, is striving to be an equal opportunities employer.

All information provide within this application form will be held in and processed in accordance with the Data Protection Act 1999.

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