Application Form

Job Title - Progression Manager

Please tell us how you became aware of this vacancy

Your personal details

Mr. Mrs. Miss Ms other
Surname / Forenames
Address (including postcode)
Phone (day) / Mobile phone
Email address
If successful, when could you start the position?
National Insurance Number
Do you have permission to work in the UK? Yes No If applicable, work visa expiry date
Please provide details of any disability, major illness, chronic conditions and/or allergies you have that may affect the application process, your work and attendance. What provisions/special help would you need us to provide to enable you to do this job?
Please state the number of days and occasions you were absent from work/school, through illness in the last two years.
Days
Occasions

Employment history

(list most recent employer first including periods of voluntary work) please attach extra sheets if required

Job/Role title / Employer
Employed from / To
Main responsibilities
Main achievements
Reason for leaving
Job/Role title / Employer
Employed from / To
Main responsibilities
Main achievements
Reason for leaving
Job/Role title / Employer
Employed from / To
Main responsibilities
Main achievements
Reason for leaving

Your Education and Relevant Training

Post Primary education –please summarise GCSEs/equivalent
Name & address of school/college/university / Dates / Qualifications & Grades
From / To
Vocational/Other relevant training courses (include name of training body, nature of course and date)
Professional Qualifications & Memberships

Supporting information

Please aim to stay within the suggested word limits. You can expand the fields on this form if you need to.

What attracted you to this position and Mencap Liverpool? (100 words)
How does this job fit with your future ambitions? (50 words)
Please tell us how your knowledge, skills, experience and personal qualities meet the person specification and equip you to fulfil the responsibilities of the role. (1000 words)

Referees

Please provide the name, address and telephone number of two referees who can comment on your work performance. One reference should be your present/most recent employer. Referees will not be contacted without your consent.

Name / Name
Title/position / Title/position
Company address / Address
Phone / Phone
Email / Email

Declarations

A satisfactory Disclosure & Barring check is necessary for this position as you will be working with children and vulnerable adults. Please indicate whether you are willing to undergo this. Yes No
Have you had any criminal convictions?Yes No If yes, please give full details. Use a separate sheet if necessary.
NB Because of the nature of the work for which you are applying, this post is exempt from the provisions of section 4 (s) of the Rehabilitation of Offenders Act 1974, (Exemptions Order 1975). Applicants are not entitled therefore to withhold information about convictions which, for other purposes, are “spent” under the provisions of the Act. Any information given will be completely confidential.
I confirm that the information provided on this application form is correct to the best of my knowledge. I acknowledge that any false or misleading statements on this form may, if they subsequently come to light, be taken to justify my dismissal from employment with Mencap Liverpool or could result in the cancellation of any job offer made.
Signed: Date:

Thank you for the time you have spent completing this application and the interest you have shown in Mencap Liverpool. Please return this form to: (email is preferred) or post to

Jacqui Bouch, Mencap Liverpool, 9 Lydia Ann Street, Liverpool, L1 5BW

Please also complete our Equality & Diversity questionnaire using the link below. This is completely anonymous and in no way linked to your application.

If you require any adjustments in order to complete the Equality & Diversity questionnaire, please telephone the office on the number below during working hours- you do not need to give your name.

T: 0151 707 8582Page 1 of 5