Application Form

Application for employment as:

1. Personal Details

Surname:
Initials:
Address, including Post Code:
Telephone:
Email:
National Insurance Number:
PVG Registration:

2. Education and training

Awarding Body (e.g. SQA) / Course/Subject/Module Titles / Level/Grade of Course
(e.g. 1,2,3 / A, B, C) / Date
Awarded / ü Tick if Awaiting Results

Please list your Further and Higher Education qualifications using the following headings:

University/College / Course Title
(e.g. HND Computing) / Subjects studied / Date Awarded / ü Tick if Awaiting Results

Training Courses relevant to this application:

Course Provider / Description of Course
(including main subject covered) / Date Awarded

3. Employment history

Present/Most recent employer:

Address inc. Post Code
Job title
Duties
Rate of pay
Date employed / From: To:
Reason for leaving
Can we contact your current employer prior to interview? / YES / NO

Period of Notice:

If appointed, how soon could you join us?

Previous employer:

Address inc. Post Code
Job title
Duties
Rate of pay
Date employed / From: To:
Reason for leaving

4. Other Relevant Experience

Please tell us about other jobs you have done and about the skills you used and/or learned in those jobs.

5. Additional Information

Please tell us why you applied for this job and why you think you are the best person for the job.

6. References

Please tick the box if you do not wish contact to be made with a referee prior to an interview being held.

Contact Name & Occupation / Address
(including Postcode) / Email address / üTick if NO Contact to be made prior to interview

7. Membership of Professional Bodies

Name of Awarding Body/Institution / Class of Membership / Date Awarded / Membership No. and Expiry Date (if applicable)

8. Driving Licence

Yes or No / Yes or No
Do you hold a current driving licence? / Full / Provisional
Does your licence hold any Penalty Points
If so please specify?
Are you currently insured to drive your car for business?
Are you currently insured to drive your car for commuting?
Do you hold MIDAS accreditation?

Please tell us if there are any ‘reasonable adjustments’ we can make to assist you in your application or with our recruitment process

Data Protection Act

I agree to North West Carers Centre (NWCC) (Edinburgh) and its agents processing, by means of information and communication technology or otherwise, any information which I provide to them contained in this application form for the purposes of recruitment and employment with NWCC, monitoring the effectiveness of NWCC’s Equal Opportunities Policy, and, in the exercise of the NWCC legitimate interests.

Declaration – to be completed by all applicants

I confirm that the information I have given on this application form is true, correct and complete. In the event of my being employed by NWCC and it is found that information or any other documents associated with the recruitment and selection process are false, or that I withheld information, this may render me liable to dismissal without notice, or in some instances, referral to the police.

I can confirm that to the best of my knowledge the above information is correct. I accept that providing deliberately false information could result in my dismissal.

Please sign using initials and surname only:

Signed: …………………………… Date: ……………………………

NWCC/BAM/OCT 2015