Date of completion:
APPLICATION FOR EMPLOYMENT
Post Applied For:
Closing Date:
PERSONAL DETAILS
Surname: / Forenames:
Address: / Tel:
Postcode: / Mobile:
Email:
REFERENCES:
Please name two persons from whom references may be sought concerning your application. One of theses must be your present/last employer. Please indicate clearly whether we may approach your referee before interview and the length of time that your referees have known you.
Name: / Mr Mrs Miss Ms / Name: / Mr Mrs Miss Ms
Address: / Address:
Postcode: / Postcode:
Tel: / Tel:
Email: / Email:
Occupation / Occupation
Approach before interview YES NO / Approach before interview YES NO
Time known years / Time known years

QUALIFICATIONS AND TRAINING

Please list below the qualifications that you have obtained in secondary school, further and higher education and professional institutes. Also list any non-qualification courses that you have attended which you consider to be relevant to your application.

Please continue on a separate sheet is necessary
QUALIFICATIONS OBTAINED / SCHOOL/COLLEGE/UNIVERSITY / DATE
Courses attended other than those above:
EMPLOYMENT HISTORY
PRESENT OR MOST RECENT EMPLOYMENT
Name and address of employer:
Post Held:
From: / To:
Grade:
Basic Salary:
Notice Required:
Brief description of duties:

OTHER EMPLOYMENT/CAREER HISTORY (Please put most recent first)

Please provide full details since leaving full-time education. You should include full-time employment, education or training and unemployment, voluntary work, raising a family, part-time work or education.

Employers Name & Address / From / To / Job Title
*Please continue on a separate page if necessary
FURTHER INFORMATION
Please explain below how your experience and skills and knowledge gained in paid or unpaid work, study or training meets the selection criteria for the post described in the person specification. Make sure you address all the criteria on the personal specification. *
N.B. CV’s are not accepted.
*Please continue on up to two separate pages if necessary
DECLARATION
I understand that the appointment if offered will be subject to the information given on this form being correct.
Signature of applicant
Print name
Date
Disclosure of Criminal Convictions

The post you have applied for is excluded from the Rehabilitation of Offenders Act 1974 by virtue of the (Exceptions order 1975 SI No.102/1975) due to the fact the employment is in connection with the provision of social services.

We therefore require from you a declaration of convictions that would otherwise be spent under the said Act.

Please provide details of all convictions, spent or unspent in the space below:

Date of conviction / Type of conviction / Sentence

I declare that the above is true and correct.


I declare that I do not have any convictions.

(Cross out any that does not apply)

Signature of applicant
“I agree” (please tick if filled electronically)
Print name
Date


Equal Opportunities Monitoring Form

Jobs In Mind is committed to the practice and promotion of equal opportunities and diversity within our work environment. We need to ask the following questions for the purposes of monitoring, evaluation, recruitment or selection. This is to enable us to provide the best possible service and to measure the effectiveness of our Equal Opportunities and Diversity policies.

1. How would you describe your race or cultural origin? (Please tick one box only)

White
White British White Irish
Greek/Greek Cypriot Turkish/Turkish Cypriot
Albanian (not Kosovan) Kosovan
Any Other White Background, please state
Mixed
White & Black Caribbean White & Black African
White & Asian
Any Other Mixed Background, please state
Asian & Asian British
Indian Pakistani
Bangladeshi
Any Other Asian Background, please state
Black or Black British
Caribbean Congolese
Eritrean Ethiopean
Nigerian Somali
Any Other Black Background, please state
Chinese Or Other Oriental Background
Chinese Other Oriental Background
(If you feel that the above categories are not appropriate please describe your ethnicity in your own words below)
Any Other Ethnic Background, please state
2. D.O.B: / 3. Gender: Male
Female
4. How did you hear about the position?
5. Do you consider yourself to have a disability as defined by the Disability Discrimination Act?
Yes No
If yes, please specify

Please return this form to Zahra Ahmed

Email: Tel: 020 3028 7936 / 07960 550774 Address: Violet Melchett Health Centre, Community Living Well Service, 2nd Floor, 30 Flood Walk, Chelsea, London, SW3 5RR