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(Formerly known as North Kent Women’s Aid) Limited

Appointment Application Form

Name:

Address:

Day time Tel. No. Evening Tel. No.

Email:

Post Applied for:

Where did you see the post advertised?

Please give the names and addresses of two referees, one of whom should be your present or most recent employer.

Do you consent to us taking up references prior to being called to interview?

Yes No

If ‘no’ please indicate which individual(s) you do not wish us to contact.

Disclosure and Barring Service Check (previously CRB Checks)

Appointment will be conditional upon an Enhanced Disclosure being satisfactorily obtained from the Criminal Records Bureau.

Rehabilitation of Offenders Act 1974

(Exemptions) Order 1975

Because of the nature of the work for which you are applying, this post is exempt from the provision of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for 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. Any information given will be completely confidential, and will be considered only in relation to applications for positions to which the order applies.

NB Applicants should be aware that providing false information to obtain employment is a criminal offence (S16 Theft Act).

Please give details below regarding any case cautions, bindovers, pending prosecutions, spent and unspent convictions.

General Information

Do you have a current full, clean driving licence? Yes/No

Do you have use of a car for work?Yes/No

Please tell us about your present and previous work experience (paid or unpaid), including the title of your job, who you were employed by or working for and the range of duties undertaken in date order. We are also interested in relevant life experience which is equally important.

Dates / Job Title and Employer / Duties Undertaken and Experience Gained
Please include reason for leaving employment

Please tell us about any training you have done, in date order, or qualifications you have which you consider relevant to the post for which you are applying.

What is your view and understanding of Domestic Abuse?

Why do you think women and men are abused within a domestic situation?

In terms of reproductive rights, what do you understand by ‘A woman’s right to choose’?

Please explain your knowledge of specialist domestic abuse servicesand why you would like to work with Choices.

Please explain some of the ways in which racism is perpetuated in our society.

Choicesstrives to be an equal opportunities organisation. What do you understand by this?

Personal Statement (what qualities could you bring to this post)

DECLARATION

I declare that the information I have given in support of my application is, to the best of my knowledge and belief, true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified or, if appointed, I may be dismissed.

Signed

Dated