(Please complete this form in black ink or type)

Job title:

Personal Details

Title / First names / Surname and suffix, if any
Are you, or have you ever been, known by any other name?
(If so, what?)
Address:
E-mail:
Telephone (w) / Telephone (h) / Telephone (m)

Where did you see this vacancy advertised?

/ National Insurance No.

Current job summary

Employer (name and address)
Type of business /

No. of employees

Job title (and grade, if applicable) /

Budget/turnover

Reporting to (job title)
Date of appointment /

Current base salary

Other benefits
Period of notice / Dates unavailable for interview
Referees

Please supply the names and addresses of two referees. Preferably, one should be related to your current or recent employment and one should be able to vouch for your knowledge, skills and experience as described in the job specification. References will not be taken up without prior agreement.

Name Name

Address Address

Telephone No. Telephone No.

Job Job

Educational qualifications
What academic qualifications do you hold?
If shortlisted, you should be prepared to provide proof of any qualifications.
Dates / Name of school, college
and/or university / Major subjects studied, examinations taken
and test results
From / To

Professional qualifications

What professional qualifications do you hold? (indicate if by full/part time or by home study.)
If shortlisted, you should be prepared to provide proof of any qualifications.

Dates

/ Award giving body
qualifications & level / Major subjects taken, where studied, examinations
taken and results

From

/

To

Previous jobs
Please give details of your employment history up to your present job.
Date started
(m/y) / Date left
(m/y) / Name, location and
business of employer / Job / Final salary / Reason for leaving

Current job details

Please describe your present or most recent job, indicating to whom you are responsible, and who is responsible to you. What do you consider to have been your major contributions in this job, and why? What are your main responsibilities and objectives? Attach copies of job description and organisation chart(s), if helpful and include dimensions, such as staff and budgets that are your accountability.

Change

Why do you wish to change?

What attracts you to this new job in particular?

Interests

How do you spend your spare time?

What is important to you outside your work?

Job requirements

Please set out below how you meet the particular competencies required by this job.
Continue on further sheets as necessary.
Are you eligible to work in the UK?
Do you have a driving licence? Full Provisional None
Do you have any medical conditions that may affect you working for WRAP. This will not affect your application. It is simply to ensure that we can make appropriate arrangements for you.
Are there any other material fact(s) which should be mentioned? If so, please state.
I confirm that, to the best of my knowledge, the information contained on this form is accurate. /

Signature

/

Date

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MONITORING INFORMATION

WRAP recognises the benefits of a diverse workforce and is committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation, religion or belief. In order to help us to monitor the effectiveness of our equal opportunities policy, we would be grateful if you would answer the questions set out below. This section of the application form will be detached and will be passed to WRAP Human Resources and will be used solely for monitoring purposes. All information provided is treated in the strictest confidence. Please note that whilst completion of this form is helpful to us, it is not mandatory.

Thank you for your assistance.

1.  Ethnic Origin

A. White

British

Irish

Other (please specify)

B.  Mixed

White & Black Caribbean

White & Black African

White & Asian

Other (please specify)

C.  Asian or Asian British

Indian

Pakistani

Bangladeshi

Other (please specify)

D.  Black or Black British

Caribbean

African

Other (please specify)

E.  Chinese or other ethnic group

Chinese

Other (please specify)

2.  Disability.

Do you consider yourself to have a disability? Yes No

If yes, please state nature of disability.

______

______

3.  Gender Male Female

4.  Religion, Sexual Orientation

If you wish you may disclose information about yourself in this section about your :

Religion ------

Sexual orientation ______

5.  How did you become aware of this vacancy?

______

______

HR/NOV2006

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