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CONFIDENTIAL

Employment Application Form

Please complete this application in either hand or typewritten format and return to:
Central Services Team, Roundabout Ltd, The Circle,
33 Rockingham Lane, SHEFFIELD, S1 4FW
Email: or
Please note that the information you provide on this form will be used for recruitment, selection and employment contract purposes only and retained in accordance with the Data Protection Act 1998.

Post Applied For

Job Title: / Reference No:
RPW5.17
Location: / Candidate No:
(Office Use only)

Personal Details

Family Name/Surname: / Address:
Forenames or Initials:
National Insurance Number:
Work Telephone Number: / Email Address:
Mobile Telephone Number: / Home Telephone Number:
Do you have the right to work in the UK? / YES / o / NO / o
Do you have a current driving licence?
Full / o / Provisional / o / No / o
Do you have current use of a vehicle?(if applicable to post) / YES / o / NO / o

Current Post (or most recent)

Position Held: / / Employer’s Name and Address:
Salary: / /
Starting Date:
Date Left (if applicable):
Reason for Leaving:
Notice Required:
Please give a brief outline of your main duties and responsibilities:
Please indicate total number of days off work due to sickness in the last 12 months: ______

Previous Employment in date order:

(Please continue on a separate sheet as necessary)
Name and Location / Position held / Reason for / Dates
of Employer / Leaving
Please give details of any training, unpaid experience or activities, which you feel are relevant to the job i.e.: voluntary work, work in the household, involvement with community groups.

Education, Qualifications & Vocational Training

Secondary Education
(from Age 11) / Qualifications/Level / Grades / Dates
Further/Higher Education / Subject/Qualifications
(if applicable) / Grades / Dates
Vocational/Relevant Training
Present Studies Details / Dates
Membership of Professional Institute/Organisations / Level / By examination Yes/No / Dates

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Experience, Knowledge, Skills & Abilities

In the following section please use the job description and person specification to relate details of your experience, knowledge, skills and abilities, either gained at work or otherwise, which you consider to be relevant to this post. Please continue on a separate sheet if necessary.
Please outline your reasons for applying to work at Roundabout and your career hopes and aspirations. Please continue on a separate sheet if necessary.

References

Please give the name and address of two people, (not relatives) who can comment on your suitability for this post. One must be your present employer (or most recent employer if you are not currently employed):
Name: / Name:
Job Title: / Job Title:
Address: / Address:
Telephone No. / Telephone No.
Email Add: / Email Add:
May we take up this reference prior to interview? / YES o NO o / May we take up this reference prior to
interview? / YES o NO o

Declarations

How did you find out about this vacancy?
Are there any dates when you would not be available for an interview?
Please give details of any provision you require if invited for interview:
Do you have any criminal convictions? Please include any, which are spent?
If 'Yes', please provide full details in a separate envelope addressed to the CEO, marked ‘Confidential’.
A criminal record may not necessarily be a bar to obtaining
a position with Roundabout. / YES / o / NO / o
Are you related to any member of the Board of Trustees or employee/s of Roundabout? /
YES
/ o /
NO
/ o
I understand that :
/
§  A medical examination may be necessary in connection with this post and that my appointment would be subject to satisfactory medical clearance;
/
§  A DBS check will be carried out
/
§  Any appointment is subject to satisfactory references
I certify that, to the best of my knowledge and belief, the information contained on this form is accurate. I understand that any false information given on this form may render an offer of employment invalid or lead to termination of employment.
Signed: ______
/ Date:______
TO BE COMPLETED BY INTERVIEW PANEL
SHORTLISTED / INTERVIEWED / APPOINTED / COMMENTS
YES/NO / YES/NO / YES/NO
If No, Reason / If No, Reason / If No, Reason
Signed: / Signed: / Signed:
Reason: / (A) Not met essential criteria / (B) Not met desirable criteria / (C) Q&E not relevant / (D) Q&E insufficient
(E) Application standard / (F) Application late / (G) Interview performance / (H) Other

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