Vista House, 1a Salisbury Road, Leicester, LE1 7QR
Email:
25 hours per week
Applegarth Home
Surname (Block Letters): / First Names:
Title:
Address (Block Letters): / Telephone Numbers:
Home:
Business:
Ext:
Mobile:
Email address:
Do you own a car? [Yes/No]
Have you a current Driving Licence? [Yes/No]
Do you have a disability? [Yes/No]
If you have a disability and meet the essential criteria of the person specification, you will be guaranteed an interview.
Present Or Most Recent Employer
Name and Address: / Nature of Business:
Present Salary/Grade:
Other Benefits:
Job Title:
Hours worked per week:
Responsible to:
Date of Appointment: / Notice Required:
Education/Training/Qualifications (Gained Or Being Studied For)
School/College/University / Qualifications / Grades
Relevant Non Qualification Courses Attended
Organising Body: / Course Details:
Outside Interests And Hobbies Etc
Previous Employment
Applicants may, if they wish, submit a Curriculum Vitae as an alternative to completing this section
Employer / Job Title
(Including a brief description of your duties) / Grade
Salary
Per Annum / Dates
DD/MM/YY
From - To / Reason for Leaving
Please tell us why you are applying for this job and what abilities and experience from paid or voluntary work you are bringing.
Please link this to the personnel specification.
Referees (One Of Whom Should Be Your Present/Last Employer)
Referees must not be related to the applicant
Name (Block Letters) / Name (Block Letters)
Address (Block Letters) / Address (Block Letters)
Telephone:
Email address: / Telephone:
Email address:
Position held by Referee / Position held by Referee
References
May references be taken up immediately? [Yes/No]
This will not necessarily mean that you will be called for interview
If No, please state reason
Please give dates in the near future that you will not be available for interview
Are you related to any Committee Member or Employee of Vista? (Such a relationship will not discriminate against you)
Please state where you learned of this vacancy
Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section (42) of The Rehabilitation of Offenders Act 1974 by virtue of The Rehabilitation of Offenders Act 1974 (Exception) Order 1975. Applicants working with children or vulnerable adults will be subject to a disclosure application to the Criminal Records Bureau.
Applicants are, therefore, not entitled to withhold information about convictions which for the other purposes are “spent” under the provisions of The Act, and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Society. Any information given will be completely confidential and will be considered only in relation to an application for positions to which The Order applies. Having a criminal record will not necessarily be a bar to obtaining employment.
Have you ever been convicted of a criminal offence or received a caution? [Yes/No]
I declare that all the information submitted is true, that I have not canvassed a member of Vista’s Management Committee or any Sub Committee either directly or indirectly, in connection with this application and will not do so. I understand that such canvassing will disqualify me as a candidate. I further understand that failure to disclose my relationship with a Member or Employee of Vista may also disqualify me and if such failure is discovered after my appointment I may be liable for dismissal without notice.
I consent to undertake such training as necessary.
I consent to any documentation provided to Vista being referred to a Government Department or agency for verification, if deemed necessary.
I consent to the information on this form being used as part of the process for assessing my suitability for employment and that if I am unsuccessful the record will be retained for a maximum period of 4 months. If successful, the application form will form part of the employment record and be retained during my period of service.
Signature ______Date: ______
When completed this Application Form should be returned to:-
Human Resources, Vista House, 1a Salisbury Road, Leicester, LE1 7QR. Alternatively, you may e-mail it to:
For Official Use Only
Start Date
Place Of Work
Position
Hours Of Work
Grade
Basic Salary
Commencing Salary
Letter Of Appointment / Offer Employment As Above
Confirm Verbal Appointment
Replacing
Senior Member of Staff ______Date ______
Reference Check
Enquiry / Reply
1 / [Yes/No]
2 / [Yes/No]
Acceptance Received [Yes / No]