(Officeuse)Unique IdentificationNumber

WELSH AIRAMBULANCECHARITABLETRUSTCharityNo1083645

ApplicationForm-CONFIDENTIAL

Applicationfor thepostof:

Pleasecompletethisformin type or blackink

PERSONAL DETAILS

Name:
Address:
PostCode:
DaytimeTelephone:Mobile:
Email:
NationalInsuranceNo:
Are you applyingfor full time/ parttime/jobshare

DISABILITYDISCRIMINATIONACT 2006

The Trustiscommittedto ensurethatdisabledpeoplereceive fairtreatment. Ifyou consideryourselfto be adisabledpersonpleasegiveinformationaboutthe arrangementstheTrustmightmaketogiveyouafairinterview. Wemayneedto contactyouforfurther information.

Assistancerequiredfor Interview:

REFERENCES

Pleaseindicatetwopeoplewho canprovide references,oneofwhomshouldpreferably beyour present/mostrecent employer

Name: / Name:
Address: / Address:
Tel No: / Tel No:
Email: / Email:
Occupation: / Occupation:
I *give/donotgivepermissiontotakeupmy referencespriorto anemploymentbeingmade / I *give/donotgivepermissiontotakeupmy referencespriorto anemploymentbeingmade
*(deleteclearlyasappropriate) / *(deleteclearlyasappropriate)

EDUCATION,TECHNICALAND PROFESSIONAL QUALIFICATIONS

Ifyou are interviewedyoushouldbringwithyou evidenceofqualifications.Thesewill becheckedandimmediatelyreturned toyou.

Schoolsattended(from age11)

Nameand Address ofSchool / Certificates Obtained
(withgrades where applicable)

Further Education

Nameand Address of
University/College / Full or PartTime / Qualifications Obtained

OtherTraining orShort Courses

Name ofOrganising
Body / SubjectsStudied / Qualifications Obtained

Membership of ProfessionalBodies

Professional Body / TypeofMembership

EMPLOYMENT

Presentand most recentemployment

Employer’s NameandAddress / PositionHeld / PresentGradeandSalary
BriefDetails ofMajorDutiesandResponsibilities:
Noticerequired: / Reasonfor Leaving:

Previous Employment (mostrecentfirst)

Employer’s NameandAddress / PositionHeld / Reasonfor Leaving

Pleasecontinueonaseparatesheet ifnecessary.

Pleasegiveyourreasons forapplying andany otherinformationyouconsiderrelevant includingwhatyoubelieveyoucancontributetothejob. Youmayuseseparatesheets if necessary.

PersonalDevelopment

PersonalDevelopment(include anycourses, membership,voluntary workor responsibilitiesyouconsider relevant,with outcomeswhereapplicable).Pleasecontinue onaseparate sheetif necessary,givingpage numberandtitleheading.

Are there anyrestrictions toyour residenceintheUKwhich mightaffectyour rightto takeupemploymentintheUK? Yes /No

IfYes, pleaseprovide details:

Ifyouaresuccessful in your application,wouldyourequireawork permit prior totaking upemployment? Yes /No

DateProtection Statement

Theinformationthat youprovideonthis formandthat obtainedfromotherrelevant sourceswillbeusedtoprocessyourapplication foremployment. The personal informationthatyougiveuswillalsobeusedinaconfidentialmannertohelpus monitor our recruitment process.

Ifyou succeed in your application and take up employment with us, the information will beusedin the administrationofyour employmentwithusandtoprovideyouwith informationabout usor third party viayour payslip.We mayalso use theinformationif there isacomplaint orlegal challengerelevanttothis recruitment process.

Wemaychecktheinformationcollected,withthirdpartiesorwithotherinformation held by us.Wealsouseor passtocertain thirdpartiesinformationtoprevent ordetect crime,to protectpublicfunds, or inother ways as permittedbylaw.

By signingtheapplicationformwewillbeassumingthatyou agreetotheprocessing of sensitivepersonaldata,(as describedabove),inaccordancewith ourregistrationwith theData ProtectionCommissioner.

Declaration

IdeclarethattheinformationIhavegiveninthisapplicationisaccurateandtrue. I understandthatprovidingmisleadingorfalseinformationwilldisqualifyme from appointmentOR,if appointed,mayresult inmydismissal.

Signature Date

Pleasereturnthecompleted applicationform to:WalesAirAmbulance

TŷElusen, Fford Angel,

Llanelli, Dafen,

Llanelli. SA14 8LQ

(AtddefnyddSwyddfa)RhifAdnabodUnigryw

YMDDIRIEDOLAETH ELUSENNOL

AMBIWLANSAWYR CYMRURhifElusen1083645

FfurflenGais-CYFRINACHOL

Cais am swydd:

Llenwchyffurflenhonmewnteipneuincdu

MANYLIONPERSONOL

Enw:
Cyfeiriad:
Cod Post:
RhifFfônynystod y Dydd:Symudol:
E-bost:
RhifYswiriantGwladol:
A ydychchi’ngwneudcais am swyddamserllawn/ rhan-amser/ rhannuswydd

DEDDF GWAHANIAETHUARSAILANABLEDD2006

Mae’rYmddiriedolaethwediymrwymoisicrhaubodpoblanablyncaeltriniaethdeg.Osystyriwch eich hun yn berson anabl, rhowch wybodaeth am y trefniadau y gallai’r

Ymddiriedolaetheugwneudiroicyfweliadtegichi.Efallaibyddangeninnigysylltuâchi amwybodaethbellach.

CymorthsyddeiangenargyferCyfweliad:

TYSTLYTHYRAU

Nodwchddaubersonsy’ngallurhoitystlythyr,dylaiunohonyntfodeichcyflogwrpresennol/diweddarafosoesmodd

Enw: / Enw:
Cyfeiriad: / Cyfeiriad:
RhifFfôn: / RhifFfôn:
E-bost: / E-bost:
Galwedigaeth: / Galwedigaeth:
*Rwyf/nidwyfynrhoicaniatâdichiofynamfynhystlythyraucyngwneudcyflogaeth / *Rwyf/nidwyfynrhoicaniatâdichiofynamfynhystlythyraucyngwneudcyflogaeth
*(dilëwchynglirfelsy’nbriodol) / *(dilëwchynglirfelsy’nbriodol)

ADDYSG,CYMWYSTERAUTECHNEGOLAPHROFFESIYNOL

Osbyddwchyncaelcyfweliad, dylechddodâthystiolaeth o gymwysteraugyda chi. Bydd y rhainyncaeleudarllena’udychwelydichiarunwaith.

Ysgoliona fynychwyd(o11 oed)

Enw a ChyfeiriadyrYsgol / Tystysgrifau a Gafwyd
(gydagraddauosyw’nberthnasol)

Addysg Bellach

Enw a Chyfeiriad y
Brifysgol/Coleg / AmserLlawnneu Ran-
amser / Cymwysterau a Gafwyd

HyfforddiantneuGyrsiauByrEraill

Enw’rCorffTrefnu / Pynciau a Astudiwyd / Cymwysterau a Gafwyd

Aelodaeth oGyrffProffesiynol

CorffProffesiynol / Math o Aelodaeth

CYFLOGAETH

Cyflogaethbresennola diweddaraf

Enw a Chyfeiriad y Cyflogwr / TeitleichSwydd / Gradd a ChyflogPresennol
MânFanylionPrifDdyletswyddau a Chyfrifoldebau:
Rhybuddsyddeiangen: / Rheswm am Adael:

CyflogaethFlaenorol (ydiweddarafyngyntaf)

Enw a Chyfeiriad y Cyflogwr / TeitleichSwydd / Rheswm am Adael

Parhewcharddalenarwahânosoesangen.

Rhowcheichrhesymauamymgeisioacunrhywwybodaetharallsy’nberthnasolyneich barn chi, gangynnwysyrhyn y credwch y gallwcheigyfrannu at y swydd. Cewchddefnyddiodalennauarwahânosoesangen.

DatblygiadPersonol

DatblygiadPersonol (gangynnwysunrhywgyrsiau, aelodaeth, gwaithgwirfoddolneugyfrifoldebausy’nberthnasolyneich barn chi, gydachanlyniadaullebo’nberthnasol). Parhewcharddalenarwahânosoesangen, ganroirhiftudalen a theitl.

Aoesunrhywgyfyngiadaui’chpreswylfayn y DU a allaieffeithioareichhawlidderbyncyflogaethyn y DU? Oes / NacOes

OsOes, rhowchfanylion:

Osbyddeichcaisynllwyddo, a fyddaiangentrwyddedwaitharnochcyndechraucyflogaeth? Byddai / Na fyddai

DatganiadDiogeluData

Bydd ywybodaeth a rowchar yffurflenhona’rwybodaethhonno a geir o ffynonellauperthnasoleraillyncaeleidefnyddioibrosesueichcais am gyflogaeth. Defnyddir y wybodaethbersonol a rowchinnihefydmewn dull cyfrinacholi’nhelpuifonitroein proses recriwtio.

Osbyddeichcaisynllwyddo a byddwchyndechraucyflogaethgydani, defnyddir y wybodaethwrthweinyddueichcyflogaethgydani ac iroigwybodaethichiamdanomnineudrydyddpartidrwyeich slip cyflog. Efallaihefyd y defnyddiwn y wybodaethosoescwynneuwrthwynebiadcyfreithiolynberthnasoli’r broses recriwtio hon.

Gallwnwirio’rwybodaeth a gesglir, gydathrydyddpartïonneuo’ichymharu â gwybodaetharallsyddgennym.Rydymhefydyndefnyddioneu’ntrosglwyddogwybodaethidrydyddpartïonpenodoliatalneuganfodtroseddau, iddiogelucyllidcyhoeddus, neumewnffyrdderaill a ganiateirgan y gyfraith.

Drwylofnodi’rffurflengais, byddwnyntybioeich bod yncytunoibrosesu data personolsensitif, (fel y disgrifiruchod), ynunolâ’ncofrestriadâ’rComisiynyddDiogelu Data.

Datganiad

Datganaffod ywybodaeth a roddaisyn ycaishwnyngywir ac ynwir.Deallaf ybyddrhoigwybodaethgamarweiniolneuffugynfyngwneudynanghymwys am y swydd NEU, oscaffymhenodi, gallaiarwain at fyniswyddo.

Llofnod Dyddiad

Dychwelwch y ffurflengaiswedi’illenwii:WalesAirAmbulance

TŷElusen, Fford Angel,

Llanelli, Dafen,

Llanelli. SA14 8LQ