APPLICATION FOR EMPLOYMENT

Please complete this form in black ink so that it may be photocopied.

You may complete this form by hand or by typing.

Position you are applying for:
Where did you see the post advertised:
Full Name:
Postal Address:
(including postcode)
Email Address:
Telephone Number:
Mobile Number:

EMPLOYMENT DETAILS

Current or most recent employer’s name:
Employer’s Address:
Job Title:
Start Date:
Current Salary:
Notice Period:
Please give a brief description of your duties and responsibilities:
Reason for leaving:

PREVIOUS EMPLOYMENT

Please give details of your past employment history in reverse chronological order (i.e. your most recent job first, including any voluntary work relevant to the role. Please add further boxes if necessary.

Dates / Name & Address of Employer / Job Title / Reason for Leaving
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
Please explain any gaps in your employment history:

EDUCATION & TRAINING

Please tell us about your education and training, including relevant work-based training. Please note that you will be asked to provide certificates to verify the information detailed in this section.

Dates / Name of education or training organisation / Title of course / Level of qualification gained
SUPPORTING STATEMENT
Before completing this section please read the Job Description and Person Specification which lists the key skills and experience that are either desirable or essential to the post. In your supporting statementyou should explain why you are applying for this post and how you meet the post’s requirements, giving specific examples wherever possible. Your examples can include experience gained either from work, home or in a voluntary capacity.
Please Note: Any statements longer than the two sides of A4 paper provided will not be shortlisted, statements must also be clearly legible, typed print must be no smaller than an 11 point font size.

REFERENCES

Please give details of two referees. One referee should be your current or most recent employer. If you are employed by more than one employer, we will require a reference from each employer. Relatives must not be used. We will only contact your references if you have a successful interview.

Referee 1

Referee’s Name:
Company:
Position:
Postal Address:
(including postcode)
Telephone:
Email:
How does this person know you?

Referee 2

Referee’s Name:
Company:
Position:
Postal Address:
(including postcode)
Telephone:
Email:
How does this person know you?

DATA PROTECTION ACT 1998

Information provided by you on this application form may be copied for use during the recruitment procedure. Once the recruitment procedure is completed, the data will be stored for six months and then destroyed. If you are the successful candidate, relevant information may be taken from this form and used as part of your personnel record.

CONFIRMATORY STATEMENT

I confirm that the information provided by me on this application form is correct and gives a fair representation of my qualifications, work experience and suitability for the post.

I consent to the use of this information during the recruitment process.

Signature: / Date:

Please return your completed application form by email to:

Or by post to: Addressee Only, Service Manager, Well Centre, 16 Wellfield Road, London SW16 2BP