Please complete this form in
Black Ink or Typescript and return by email to or by post to: / Administrator
Hart Voluntary Action Limited
Civic Offices
Harlington Way
Fleet
Hants GU51 4AE
Application for employment as:
Facilitator –
Sunshine & Showers / Closing date: Monday, 31st July 2017
Where did you see the vacancy?
Personal Details
Last Name: (block capitals)
First Name(s):
Address for correspondence:
Postcode:
Home Tel No:
Work Tel No:
May we contact you at work:
(Please delete as appropriate) / Yes / No
Mobile No:
Email:
Employment Experience - Present Employer
Name of Employer:
Address:
Current Position:
Date Started:
Reasons for Leaving:
Current Salary / Grade:
Briefly describe your duties:
Previous Jobs (most recent first)
(If you have gaps in employment due to caring for family or unemployment etc please specify accordingly)
Name of
employer / Date from
Mth Yr / Date to
Mth Yr / Position held and
main duties / Reason for
leaving
Qualification and training relevant to the Job
Please list here any relevant qualifications and training you have undertaken which are relevant to
the Person Specification. Please include membership of professional bodies.
Educational Background
If you are offered the position you will need to provide evidence of qualifications obtained
Name of School,
College/University,
Educational
establishment
attended / Month and Year of
attendance and
completion / Subject / Qualifications
Obtained / Year
Awarded
From / To
Training attended which is relevant to job:
Training course & Year Awarded
Are you a member of any professional or
technical body?
If yes, please list
Knowledge
Please use this space to show that you have the knowledge asked for in the Person Specification
Experience
Please use this space to show that you have the experience asked for in the Person Specification gained through work, home or voluntary activities.
Skills & Abilities
Additional Information
Please do not attach a CV; do not exceed 1.5 sides of A4 paper
References
Please give the names and addresses of two references and state in what capacity you are known to them. One should be your present or previous employer.
1. Full Name: / 2. Full Name:
Address: / Address:
Postcode: / Postcode:
Tel No: / Tel No:
Email: / Email:
Occupation: / Occupation:
Capacity in which known: / Capacity in which known:
Do you agree to a Disclosure Barring Service (DBS) Check if the role warrants one? / Yes / No
Public funds must be protected and so information you have provided on this form may be used to prevent fraud. The information may also be shared, for the same purposes, with other organisations, which handle public funds. I can confirm that to the best of my knowledge the information provided on this form is correct and gives a fair representation of my qualifications and employment history.
I declare there is no legal impediment to my entering into employment with the Hart Voluntary Action Limited and that I am eligible to work in the UK. [KH1]
Signature: Date:

Private and Confidential

Declaration

The post for which you have applied is exempt from the provisions of the Rehabilitation of Offenders Act 1974. As a consequence, you are required to notify any convictions that you may have received, including those that may be regarded as “spent” under the provisions of the Act, by completing the schedule below. If you have no convictions to declare you should write “No Convictions” in the Conviction column and date and sign the form.

Schedule:

Date / Court / Offence / Conviction
Name in full:
Address:
Postcode:
Signed:
Date:


Hart Voluntary Action (HVA) is committed to supporting equality of opportunity and works toward ensuring that everyone has an equal opportunity for access to employment, volunteering or services. Please help us monitor the effectiveness of our equality and diversity policies by answering the questions below.

It is HVA policy that all personal data relating to staff, volunteers and service users, either paper based or electronic is processed, in compliance with UK legislation governing Data Protection. The information you provide through this form will be used only for monitoring purposes and will be kept anonymous and confidential with accessibility restricted to only those who require the information.

Please tick as appropriate

Gender
Male
Female
I prefer not to say / Current Employment
Full-time work
Part-time work
Unwaged
I prefer not to say / Disabilities
A physical disability
Mental ill health
Registered disabled
I prefer not to say
Age
18-24 years
25-34 years
35-39 years
40-59 years
60-65 years
I prefer not to say / Please select the option which best describes your sexuality
Lesbian
Heterosexual
Gay
Bisexual
I do not wish to disclose my sexual orientation
Ethnic Origin
Asian
Bangladeshi
Indian
Pakistani
Any other Asian background / Black
African
Caribbean
Any other Black background / White
British
Irish
Any other White background
Mixed
Asian & White
Black African & White
Black Caribbean & White
Any other mixed background / Other Ethnic Group
Chinese
Any other ethnic group / Undisclosed
I do not wish to disclose my ethnic origin
Please indicate your religion or belief
Atheism
Buddhism
Christianity
Hinduism / Muslim
Jainism
Judaism / Sikhism
Other
I do not wish to disclose my religion/belief

How did you hear about this Vacancy; Volunteer Opportunity; Service (delete as appropriate)

………………………………………………………………………………………………………………………………………………………..……Thank you for your help

1

[KH1]Addition of wording re ‘Right to Work in the UK’ – 21.12.16