Application form for post of

Survivor’s Service Manager

Personal Details

Surname: / First names:
Mr/Mrs/Miss/Ms/Other title: / Email:
Home address:
Postcode:
Home tel: / Mobile: / Work tel:
First spoken language / Other languages (including signing and symbols)

Education Please describe any education (from age 11)

From - To Month/Year / The school/college/organisation which provided the education / Examination passed

TRAINING Please describe any relevant training and professional qualifications

From - To Month/Year / The organisation which provided the training / Details of training or professional qualifications

employment status

Do you currently have valid permission to live and work in the UK? (strike out as applicable)YES/NO

employment HISTORY Please start with current/most recent employment.

Employer’s name
and address / Job title and main duties
(full or part-time) / Reasons for leaving / From - To Month/Year

supporting statements Please tell us why you are applying for this job and demonstrate your suitability for the post, paying careful attention to the person specification. (Please continue on a separate sheet if necessary)

references Please give the names and addresses of two referees – one of which must be your current/most recent employer. References will only be taken up if you are offered employment.

Name: / Name:
Position: / Position:
Address: / Address:
Relationship to you: / Relationship to you:
Tel no: / Tel no:

rehabilitation of offenders act Because of the vulnerability of the people we work with, the Exemption Order of this Act allows us to ask about the criminal background of applicants. Please list any criminal convictions you may have, including those which may in other circumstances be considered spent. We reserve the right to make police checks on applicants.

Have you ever been cautioned or convicted of a criminal offence by a court of law? YES/NO
If YES, Date of offence: / Place:
Offence:

declaration I confirm to the best of my knowledge that the information given on this application is true and correct and can be treated as part of any subsequent contract of employment.

Signed: / Date

Please return this form as soon as possible to:

RESPOND, 3rd Floor,

24-32 Stephenson Way, LondonNW1 2HD

If you use continuation sheets, please mark them clearly with your name.

equal opportunities monitoring

Respond is committed to opposing all forms of discrimination and is working to ensure this aim becomes a reality in practice. Please help us monitor the effectiveness of our equal opportunities policy by completing this form. The information you provide is confidential and does not form part of your application.

DISABILITY

Do you consider you have a disability? /  Yes No
If YES, what is the nature of your disability?
Please tick if you require special facilities or assistance at interview or with any aspect of the job, and please let us know what they are if you are invited for interview

ETHNIC GROUP

Please tick the box that best describes your ethnic origin
Bangladeshi
Black African
Black Caribbean
Black Other (please specify) ......
Chinese
Indian
Irish
Pakistani
White
Other (please specify) ......

GENDER AND AGE

Are you:Male?Female? 
Age: please tick one of the following:
18 – 25 26 – 40 41 – 65 66 + 
Please indicate where you saw this post advertised:
The Guardian……………………… 
Flyer………………………………… 
Internet………………………………
Other………………………………… ……………………………….

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