Challengers Application Form

Complete this form and return it by email to or post it to HR at Challengers, Stoke Park, Guildford, Surrey, GU1 1TU.

PERSONAL INFORMATION

WHAT POST ARE YOU APPLYING FOR?
JOB ROLE: / PLEASE SELECT / SCHEME: / PLEASE SELECT / DATE: / INSERT DATE /
TITLE / CHOOSE TITLE / FORNAME / ENTER HERE / SURNAME / ENTER HERE /
FIRST LINE ADDRESS / ENTER TEXT HERE /
TOWN / ENTER TEXT HERE /
POSTCODE / ENTER TEXT HERE /
EMAIL / ENTER TEXT HERE /
MOBILE / ENTER TEXT / TELEPHONE / ENTER TEXT / ALT. CONTACT / ENTER TEXT /
PLEASE NOTE WE DO MOST OF OUR COMMUNICATION VIA EMAIL

OTHER INFORMATION

HOW DID YOU HEAR ABOUT THIS VACANCY? / PLEASE SELECT /
DO YOU HOLD A FULL DRIVING LICENSE? / PLEASE SELECT /
DO YOU HAVE USE OF A CAR? / PLEASE SELECT /
IF REQUIRED, DO YOU HAVE A PERMIT TO WORK IN THE UK / PLEASE SELECT /

DISCLOSURE

The position for which you are applying potentially involves significant unsupervised contact with children and is therefore subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means that you must disclose details of any convictions, bind over orders or police cautions, warnings or reprimands, including those which are considered “spent” under the terms of the Act. This information will not be used to discriminate against you unfairly.

DISCLOSURE DECLARATION
Do you need to complete a disclosure form? If “yes” please complete the final page of this application form. / ☐YES
☐NO

EDUCATION & WORK HISTORY

EDUCATION & QUALIFICATIONS
DATE FROM / DATE TO / COLLEGE/UNIVERSITY / QUALIFICATION
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT /
EMPLOYMENT HISTORY (FULL & PART TIME, PAID & UNPAID) LIST IN ORDER WITH MOST RECENT FIRST
DATE FROM / DATE TO / NAME & ADDRESS OF EMPLOYER / JOB TITLE & DUTY / SALARY & REASON FOR LEAVING
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT / ENTER TEXT /
INSERT DATE / INSERT DATE / ENTER TEXT / ENTER TEXT / ENTER TEXT /

SUPPORTING INFORMATION

Please tell us why you are applying for this role, plus any relevant experience to support your application with particular reference to the job description. This statement is crucial to further consideration of your application.

ENTER TEXT HERE

REFERENCES

Please supply full contact details of two people who will provide a reference for you. Please do not supply both from the same place of work or education. One MUST be from your CURRENT or MOST RECENT employer or, if you are a full-time student, from your place of education. Referees may NOT be members of your family.

REFEREE 1
TITLE / CHOOSE TITLE / FORNAME / ENTER HERE / SURNAME / ENTER HERE /
ORGANISATION / ENTER TEXT HERE /
RELATIONSIP TO YOU / ENTER TEXT HERE /
FIRST LINE ADDRESS / ENTER TEXT HERE /
TOWN / ENTER TEXT HERE /
POSTCODE / ENTER TEXT HERE /
EMAIL / ENTER TEXT HERE /
TELEPHONE / ENTER TEXT / ALT. CONTACT / ENTER TEXT /
MAY WE CONTACT THIS PERSON NOW? / PLEASE SELECT /
REFEREE 1
TITLE / CHOOSE TITLE / FORNAME / ENTER HERE / SURNAME / ENTER HERE /
ORGANISATION / ENTER TEXT HERE /
RELATIONSIP TO YOU / ENTER TEXT HERE /
FIRST LINE ADDRESS / ENTER TEXT HERE /
TOWN / ENTER TEXT HERE /
POSTCODE / ENTER TEXT HERE /
EMAIL / ENTER TEXT HERE /
TELEPHONE / ENTER TEXT / ALT. CONTACT / ENTER TEXT /
MAY WE CONTACT THIS PERSON NOW? / PLEASE SELECT /
PLEASE READ AND SIGN THIS SECTION
I confirm that the information which I have given is true and complete.*
I consent for Challengers to carry out the necessary Disclosure and Barring Service checks, and to monitor status of a check on line using the DBS Update Service if this is subscribed to.
I have read and understand the job description and The Challengers Approach.
By submitting this application to us you are declaring your consent.
SIGNED** / TYPE YOUR FULL NAME HERE / DATE / INSERT DATE

* Any false statements or omissions may result in dismissal.

**If you have emailed this form to Challengers, you will need to sign a printed version at interview

COMMUNICATION PREFERENCES

We really want to keep you up to date with what is happening at Challengers, all the great news stories and information about events you could come along to which help raise vital funds so that we can support more disabled children and their families.Please tick the boxes below so we know what you would like to hear about.Please note you can read our full privacy policyhere.

E-News ☐ Events ☐

EQUAL OPPORTUNITIES MONITORING

Challengers is committed to achieving a Play and Leisure service which provides equality of opportunity and freedom from unlawful or unfair discrimination. Our policy covers all aspects of our operations, including recruitment. Please complete this part of the form. This information will be used only in order to monitor our recruitment processes and prevent unfair discrimination on any grounds.

FORENAME / ENTER HERE / SURNAME / ENTER HERE /
GENDER / PLEASE SELECT /
DISABILITY / PLEASE SELECT /
HOW WOULD YOU DESCRIBE YOUR ETHNIC BACKGROUND?
WHITE / ☐BRITISH
☐IRISH
☐OTHER WHITE BACKGROUND / DUAL HERITAGE / ☐WHITE & BLACK CARIBBEAN
☐WHITE & BLACK AFRICAN
☐WHITE AND ASIAN
☐OTHER MIXED BACKGROUND
ASIAN OR ASIAN BRITISH / ☐INDIAN
☐PAKISTANI
☐BANGLADESHI
☐OTHER ASIAN BACKGROUND / BLACK OR BLACK BRITSH / ☐BLACK CARIBBEAN
☐BLACK AFRICAN
☐OTHER BLACK BACKGROUND
CHINESE / ☐CHINESE / OTHER ETHNIC GROUP OR BACKGROUND / EXPAND OR SPECIFY HERE /

DISCLOSURE

THIS SECTION ONLY NEEDS TO BE COMPLETED IF YOU SELECTED “YES” ON PAGE 1 OF THIS APPLICATION

The position for which you are applying potentially involves significant unsupervised contact with children and is therefore subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. If you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198, please complete the information below and return it with your application. This information will not be used to discriminate against you unfairly.

For more information on the Rehabilitation of Offenders Act please go to:

DISCLOSURE
TITLE / CHOOSE TITLE / FORNAME / ENTER HERE / SURNAME / ENTER HERE /
FIRST LINE ADDRESS / ENTER TEXT HERE /
POSTCODE / ENTER TEXT HERE /
DETAILS OF YOUR CRIMINAL RECORD
DATE / NATURE OF OFFENCE / PLACE OFFENCE OCCURRED AND COUR WHICH ISSUED CONVICTION / DEATAILS OF CONVICTION, BIND OVER, CAUTION OR WARNING
INSERT DATE / ENTER HERE / ENTER HERE / ENTER HERE /
INSERT DATE / ENTER HERE / ENTER HERE / ENTER HERE /
INSERT DATE / ENTER HERE / ENTER HERE / ENTER HERE /
I DECLARE THE ABOVE INFORMATION IS ACCURATE AND COMPLETE
SIGNED** / TYPE YOUR FULL NAME HERE / DATE / INSERT DATE

It is our policy to employ the most suitable personnel and ensure equality of opportunity in the advancement of employees and not to discriminate against any person on the grounds of age, race, national origin, sex, marital status, disability or sexuality.

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Challengers, Stoke Park, Guildford, Surrey, GU1 1TU | 01483 579 390 |

Registered Charity No. 1095134, A Charitable Company limited by guarantee No. 4300724