CONFIDENTIAL

Application for employment

We welcome applications from all sections of the community

Job title / Community Enterprise Catalyst–Hertfordshire

Personal details

Title
Surname
First names
Address
Post code
Email address
Telephone contact number / Home
Mobile
Work
Preferred telephone number / Home Mobile Work
I confirm that I am over 18 years of age / Yes
Where did you hear about this vacancy?

Educational and professional qualifications

Please give details of education since the age of 16
Include academic, vocational, professional qualifications and awards
Subject/qualification / Place of study / Grade/result / Year obtained
Qualifications currently being pursued
Subject/qualification / Place of study / Level / Expected completion date

Training courses attended

Please give details of training courses that you have attended or details of courses that you are currently undertaking which you consider relevant to your application
Course title / Training provider / Duration / Year obtained
or expected
completion date

Membership of professional bodies, Societies or institutions

Professional body / Membership or registration type / Membership/Registration number / Expiry/renewal date

If relevant to the post

Do you hold a valid driving licence? / Yes No
Do you access to a vehicle which you can use? / Yes No

Employment history

Please record below the details of your current or most recent employer
Job title
Employer name
Employer address
Reporting to
Start date / End date
Period of notice required
Description of your duties and responsibilities and details of those responsible to you
Please record details below of your previous employment
Beginning with most recent first - continue on separate sheet if necessary
Employer’s name and address / Position held / Dates / Reason for leaving
From / To

Further information

Please indicate how you match the requirements of the post as contained in the person specification and include details of any relevant activities outside work
Continue on a separate sheet if necessary

Rehabilitation of Offenders Act 1974

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the act? / Yes No
If Yes, please give details
Do you have a current DBS check?
(Confirmation will be required) / Yes No
Please note that, because of the nature of the work, such employment is exempt from provisions of Section 4 (2) of the Rehabilitation of Offenders Act, 1974 (Exemptions) order, 1975 (as amended in 2013). Applicants are not entitled, therefore, to withhold any information about convictions which, for other purposes, are “spent” under the provisions of the Act. Any failure to disclose such convictions and, of course, any other convictions could, if the applicant is given employment, result in dismissal or disciplinary action.

References

Please give names and addresses of 2 referees
1 of whom must be your present/most recent employer
and 1 other person who would know you in connection with your work
Please indicate if you are known to your referee(s) by a different name
Referee 1 / Referee 2
Name
Address
Telephone number
Email address
Capacity in which you are known to them
References for shortlisted applicants may be taken up prior to an interview.
Please indicate if you are happy for us to contact your referee(s) at this stage / Yes No / Yes No

Declaration

1 / I acknowledge that an appointment, if offered, will be subject to satisfactorily medical clearance/references/compliance with the Asylum & Immigration Act and a clear DBS check where applicable
2 / I declare that the information given on this form is correct and understand that on appointment any misleading statements or deliberate omissions may be regarded as grounds for dismissal
3 / I acknowledge that any information submitted in pursuit of my application may be held on computer and manual files and therefore falls within the provisions of the Data Protection Act
4 / I declare that I am not aware of any health issues which will prevent me from undertaking this role
Signature
Date
Please return completed forms in hard copy only to:
Jill Wighton
Community Catalyst CIC
York House, 10 Haywra Street, Harrogate, HG1 5BJ
The information collected on this form will only be used in the recruitment selection process, it will be held securely within the organisation for only the required time needed to complete the processand it will not be shared with any other parties.

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