JOB APPLICATION FORM

Post applied for:
Surname: / Title:
Forenames:
Full Address:
Contact telephone number:
Email:
Do you hold a currentUK driving license? Yes/No
Are there any restrictions placed on your working activity by the Home Office? Yes/No
Are you registered disabled? Yes/No
If successful, when could you take up your appointment:
How did you hear about this post?

Education

Name of secondary school/college/university / Dates attended / Qualifications/Grades (from A’level onwards)
From / To

Employment: Please start with your present employment

Dates
From/To / Employer’s
Name and Address / Job title, brief description of main responsibilities
and reason for leaving

Training and development

Please give details of any relevant training and development within the last five years

Course / Subjects covered / Length
of course

Referees

Please give details below of two people we may contact for reference. At least one referee should be your current employer (if relevant).Please note we do not request references until an offer of employment is made.

Referee 1
Name:
Occupation/Job title:
Organisation/Address:
Telephone/email
Referee 2
Name:
Occupation/Job title:
Organisation/Address:
Telephone/email address

Information to support your application

Please use this opportunity to support your application, giving your reasons for applying and what you can bring to the role, particularly showing how you meet the requirements of the job description and person specification. (Please continue on a further sheet if necessary).

Declaration

I certify that all particulars given are true and correct. I understand that employment with WellChild is subject to receipt of satisfactory references and CRB clearance.

Signature of Applicant …………………………………………Date:……………….....

Please email completed application form and any attachments post (marked ‘confidential’) to:

Vanessa Snell

Director of Operations

WellChild

16 Royal Crescent

Cheltenham

Gloucestershire

GL50 3DA

Data Protection

The information supplied on this form is being collected as part of WellChild’s recruitment and selection procedures. By signing and returning this form you consent to WellChild using and keeping informationabout you provided by you – or third parties such as referees – relating to your application in accordance with the Data Protection Act 1998(the Act). The information you providewill be kept confidentialandwill onlybe disclosedin accordance with the Act and with WellChild's formal Notification to the Information Commissioner, for example to those involved in the selection procedure. If you are successful this form will be retained on your personal file. Unsuccessful applications will be retained for six months, after which time they will be destroyed.Under the Act you have the right to ask to see any personal data which WellChild hold about you. Information about your rights under the Act is available from the Information Commissioner at.

Equal Opportunities in Employment

WellChild is committed to having a workforce that reflects the diverse make up of communities in Gloucestershire. To help us achieve this objective, job applicants are asked to provide particular information so that we have an accurate picture of our workforce. Please complete this part of the application form so that we can check whether we are, in fact, receiving applications from all sections of the community, that candidates receive fair and equal treatment at all stages and that we comply with the relevant legislation.

This monitoring form will be separated from the rest of the application form immediately on receipt and before the selection of candidates for interview takes place. The information you give is confidentially managed and does not affect your application. It will greatly assist us if you provide as much information as possible, but you are not obliged to do so.

What is your ethnic group?
 Choose one section from (a) to (e) then tick the appropriate box to indicate your cultural background:
(a)White
British
Irish
Any other White background
please write in below / (b)Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
please write in below / (c)Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
Please write in below
(d)Black or Black British
Caribbean
African
Any other Black background
Please write in below / (e) Chinese or Other ethnic
Chinese
Any other
Please write in below / Would rather not state

Do you consider yourself to have a disability? Yes No Would rather not state

Which of the following best describes your religion/belief?
BuddhistChristianHinduJewishMuslimSikhNone

Other (please specify) Would rather not state
Which of the following best describes your sexual orientation?
Heterosexual / Gay / Lesbian / Bisexual / Would rather not say
Which of the following best describes your gender?
Male / Female / Date of Birth: / Age:
Transgender: Is your gender identity the same as your gender at birth? Yes No

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16 Royal Crescent∙Cheltenham∙Gloucestershire ∙GL50 3DA

Telephone: 01242 530007 Fax: 01242 530008

Registered Charity No: 289600