Project & Volunteer Support Worker Application Form

Title: Mr / Mrs / Miss / Ms
Other please state: / Address:
Surname:
Forenames:
Telephone:
Email address:

Education / Qualifications

School / College
Include secondary education, part-time & adult educations courses / Qualifications / Dates

Continue on separate sheet if required

Training Courses Attended

Course attended and provider / Dates

Continue on separate sheet if required

Previous Employment

Please put present/most recent employer first and include any voluntary work.

Employer
Please state name and address / Position held and reason for leaving / Dates

Please continue on separate sheet if required.

Supporting Information

Please give details of any information that you feel is relevant to the job or any information that you think may assist us in deciding your suitability for the post. Continue on a separate sheet if you wish.

Other Activities / General Interests:

Hobbies, Sports, Clubs, Societies:

References

Please give the names and addresses of two people who have agreed to supply references for you. Please include your present or most recent employer.

Referees should not be relatives.

These referees may be contacted before interview.

Name:
Address:
Post Code:
Telephone:
e-mail address:
How is this person known to you:
Have you ever been convicted of an offence in any criminal proceedings in any court?
Yes / No
Have you ever been found guilty of violent, cruel, indecent or dishonest behavior?
Yes / No
If you have answered yes to either of these two questions please give details on a separate sheet of paper.
Do you hold a current clean driving license? Yes / No
Are you a car owner? Yes / No
Do you consent to a police check being carried out on you? Yes / No
Are you able to work through the medium of Welsh? Yes / No
How many days off through illness have you had in the last 2 years? Please give reasons for such absences?
Where did you hear about this vacancy?

Rehabilitation of Offenders

Because of the nature of this work for which you are applying, this post is exempt from the provisions of section 4 of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) 1975. Applicants are therefore not entitled to withhold information of convictions which for other purposes are ‘spent’ under the provisions of the Act and in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by the Organisation. Any information given will be considered only in relation to an application for positions to which this order applies.

I declare that the information that has been given on this form is correct to the best of my knowledge.

Signature:______

Date:______

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Closing Date: Friday 2ndFebruary, 12noon