Darlington Citizens Advice Bureau
Bennet House
Horsemarket
Darlington
DL1 5PT /

APPLICATION FORM

Post applied for: GOLD Co-ordinatorClosing Date: 10.00am Friday 24 April 2015

Where did you see this post advertised?

Surname: Initial(s):

Address: Tel. Home:

Tel. Mobile:

E-mail:Tel. Work:

(if we may contact you there)

National Insurance no:

EDUCATION AND QUALIFICATIONS from age 16, including professional qualifications

SUBJECT / QUALIFICATIONS OBTAINED / GRADE

PROFESSIONAL DEVELOPMENT

COURSES, QUALIFICATIONS, MEMBERSHIP OF PROFESSIONAL BODIES / DATES
EMPLOYER’S NAME/ADDRESS / POSITION HELD WITH BRIEF DETAILS
DATE APPOINTED:
SALARY: / NOTICE REQUIRED:

PREVIOUS EMPLOYMENT in order: most recent first

EMPLOYER’S NAME/ADDRESS / DATES (FROM/TO) / POSITION HELD WITH BRIEF DETAILS

ADDITIONAL INFORMATION

Please tell us why you think you are a suitable candidate for this post and clearly indicate your relevant skills and experience, using the criteria in the Person Specification as a guide.

Please continue on a maximum of one additional sheet if required

REFEREES

Please provide details of two people who can comment on your suitability for the post. One should be your current or immediate past employer; the other could be someone who knows you in a work-related, voluntary or academic capacity.

Name:
Address:
Phone no:
E-mail: / Name:
Address:
Phone no:
E-mail:
YES/NO / May we approach these referees prior to interview? / YES/NO

PREVIOUS CONVICTIONS

Posts within Darlington CAB which may involve substantial contact with children and vulnerable adults are exempt from the Rehabilitation of Offenders Act, 1974. You are required to declare any convictions or cautions you may have received, even if they would otherwise be regarded as ‘spent’ under this Act. For such posts, Darlington CAB is also entitled to undertake checks for the existence and content of any criminal record of applicants. Information received will be kept in strict confidence and will be destroyed once the selection process is completed. The disclosure of a criminal record will not debar candidates unless it is considered that the conviction renders them unsuitable. Failure to declare a conviction may, however, disqualify you from appointment, or result in summary dismissal.

Please list any convictions and cautions.

CANDIDATES WITH DISABILITIES

If you consider yourself to be disabled, please use the space below to let us know if you require us to make any reasonable adjustments to the shortlisting process or to provide information you wish us to take into account when considering your application.

DECLARATION

Data Protection Statement: I consent to this information being processed and stored for the purpose of recruitment and selection by Darlington Citizens Advice Bureau, and if appointed, for the purposes of employment at the bureau. I confirm that to the best of my knowledge, the information I have provided on this application form is true and correct. I understand that if appointed on the basis of false information contained in this form, I may be summarily dismissed.

If you are sending your application form by e-mail, please mark this box
(as a substitute for your signature) to confirm that you agree to the above declaration.

Signed: Date:

Equal Opportunities Monitoring Form

Darlington Citizens Advice Bureau aims to be an Equal Opportunities employer. All decisions relating to employment are made with regard only to the requirements of the job. No employee, job applicant, board member or service user will be discriminated against by reason of race, colour, ethnic background, gender, disability, sexual orientation, marital status, age, class, religion or political beliefs or activities. Darlington CAB is committed to monitoring this policy to ensure that it is fully and fairly implemented.

To assist us in this task we should be grateful if you would answer the following questions and return this form with your application.

The information you provide is for statistical purpose only. It will be treated in strict confidence and will not be seen those involved in selection procedures. Answering these questions is not obligatory.

Post applied for:

Please tick appropriate boxes:

Are you? FemaleMale

Is your age?Under 1818-2426-3940-5960+

Do you have any dependants (children/elderly relatives/other)?YesNo 

Do you consider yourself to be disabled?YesNo

If yes, please give details: ______

Nature of Origin: do you consider yourself to be:

BangladeshiBlack, AfricanBlack, CaribbeanBlack, Other  British Asian  Chinese 

IndianPakistaniWhite, British

White, EuropeanWhite, OtherOther

If ‘Other’, please specify:______

Sexual orientation: how would you describe yourself:

BisexualGay woman/lesbianOther (please specify)

Gay man Heterosexual/straight ______

______

Please Note: Our Equal Opportunities Policy and Monitoring Form and procedures are under constant review. We welcome any comments or suggestions from applicants about these documents. Copies of the full Equal Opportunities policy are available on request.