Applicant Ref No:

APPLICATION FORM

Post applied for: Project Coordinator – RUN-UP

PERSONAL DETAILS

This page is removed prior to shortlisting. Your application will be assessed only on the evidence you provide relating to the qualifications and experience required for the post. Applications with CVs attached will be rejected.

Title: / Surname:
Forenames:
Home Address:
Telephone Number: / Home: / Work:

Applicant Ref No:

SECONDARY EDUCATION

School/College / Dates / Examinations Passed

From

/ To

FURTHER EDUCATION

College,Centre or
University Attended / Dates / Details of Courses &
Examinations Passed

From

/ To

OTHER RELEVANT TRAINING & SHORT COURSES

School/College / Dates / Examinations Passed

From

/ To

Applicant Ref No:

EMPLOYMENT

Give details of your work experience to date, paid and unpaid/voluntary situations. Please list them chronologically starting with your current or most recent employment.

From / To / Employer’s Name &

Address

/ Job Title and Details of Key Areas of Responsibility

EVIDENCE OF SUITABILITY FOR THIS POST

Please state, giving specific examples, how your experience and training, gained both inside and outside of your paid work, or through study, would enable you to fulfil the duties of this post. Please relate your answers to the duties on the job description and the criteria listed in the person specification.

REFERENCES

Please provide details of two referees, one of whom should be your present or most recent employer.

Referee 1 / Referee 2
Name:
Address:
Position:
How do they know you?

Can we take up references prior to an offer of the position? ______

How soon would you be able to take up the position if it was offered to you? ______

Where did you see this position advertised? ______

Are you eligible to work in the UK Yes o No o (all applicants will be asked to provide evidence).

The successful applicant will be required to complete a CRB disclosure.

Rehabilitation of Offenders Act:
Have you ever been convicted of a criminal offence by a Court of Law (with the exception of minor motoring offences or offences committed as a juvenile under the age of 16)?
PLEASE CIRCLE YES / NO
If YES, please give details and dates (this will not necessarily debar you from appointment).
Signed: ______Date: ______
Please sign above whether you have answered Yes or No.
Health:
Please give details of any illnesses over the past 5 years that have prevented attendance at work for more than a week, and of any on-going treatment or disabilities.

I hereby declare the above information to be a true account.

Signed: ______Date: ______

Please return this form to:

Margaret Summers, Redbridge Concern for Mental Health,

98-100 Ilford Lane, Ilford, Essex IG1 2LD