APPLICATION FORM – PERSONAL DETAILS

Please type or write in black ink using additional paper as necessary.

Please note that this front sheet will be detached prior to shortlisting.

Role that you are applying for:

Last Name:

First Names:

Address:

Postcode:

Telephone – Daytime:

Telephone – Evening:

Telephone – Mobile:

Email:

Please note all roles will require a standard or enhanced Criminal Records Bureau disclosure after appointment. However Cambridge House actively supports application of ex-offenders and having a criminal record will not necessarily bar future volunteers or employees.

SKILLS AND EXPERIENCE

Please outline your previous experience which demonstrates that you have the necessary skills and abilities to meet the requirements of the role as outlined in the role description and role specification.

Please use no more than two additional pages in a font no smaller than 12pt. Please do not send a C.V

EMPLOYMENT HISTORY

Current or most recent employment (including voluntary work)

Name of employer:

______

Address:

______

______

______

______

Postcode:

______

Post held:Date employed:Salary

______

Main duties:

______

______

______

Reason for leaving:

______

Previous Employment(Paid and/or unpaid) starting with the most recent: Please use additional sheets if necessary

Employer’s nameTitle of Main dutiesDates employedReason for

Post heldleaving

______

______

______

______

______

______

______

______

EDUCATION AND TRAINING

Please give details of any vocational or professional training, short courses etc, relevant to this role.

Course titleOrganisationDates

______

______

______

______

References

Please give details of two people who know you well who we can contact after the interview: The first reference should be your present or most recent employer (for paid or unpaid work). The second reference should be someone who can comment on your ability to carry out this role.

FIRST REFERENCESECOND REFERENCE

NameName

______

PositionPosition

______

AddressAddress

______

______

______

PostcodePostcode

______

If successful when could you start:

Where did you see this role advertised?

Signature:Date:

(Electronically signed application forms are satisfactory. For this please simply type you name in the requested field).

Cambridge House

Disclosure of Criminal Convictions for Exempt Posts

By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) order 1975, and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders 1986 and 2009, the post which you have applied for is exempt from Section 4 (2) of the Act in order to protect the public. We are therefore required to ask you to disclose all current or spent criminal convictions, bind over orders and cautions.

Any such information will be treated in the strictest confidence and will only be used in consideration of your suitability for volunteering or employment in the exempt post.

If you knowingly conceal or omit to include any relevant facts, and discovery is made after you have been appointed then you may be dismissed without notice. Cambridge House will undertake a standard or enhanced Criminal Records Bureau disclosure for all successful candidates.

Please complete the disclosure below and return it to Cambridge House.

Disclosure: I hereby declare the following criminal convictions, bind over orders and cautions with details of sentences and dates. (If none please state NONE).

Conviction/order/caution/PenaltyDatePlace

______

______

______

Name:Post applied for:

______

Signature:Date:

______

Electronically signed application forms are satisfactory. For this please simply type you name in the requested field.

CONFIDENTIAL

EQUAL OPPORTUNITIES MONITORING

Please complete this form to help us to monitor equal opportunities within Cambridge House and the Community Organisers Programme. Your responses will not be made known to any member of the interview panel and will be kept separately from your application. The information will be treated as strictly confidential and will be used for the purposes of equal opportunities monitoring only. Information entered on this form may be held on computer files.

PLEASE TICK THE RELEVANT BOXES OR COMPLETE THE INFORMATION AS REQUIRED.

  1. Are you

Male [ ]Female [ ]

  1. Are you aged

Under 18 [ ] 18-30 [ ] 31-40 [ ] 41-50 [ ] 51-60 [ ] 60-65 [ ] Over 65 [ ]

  1. What is your status?

Single [ ] Married [ ] Co-habiting [ ] Separated [ ] Divorced [ ]

No Comment [ ]

  1. Which ethnic group would you say you belong to?

CATEGORY / CODE / TICK
White – British / W1
White – Irish / W2
White – Other / W9
Mixed – White & Black Caribbean / M1
Mixed – White & Black African / M2
Mixed – White & Asian / M3
Mixed – Other / M9
Asian or Asian British – Indian / A1
Asian or Asian British – Pakistani / A2
Asian or Asian British – Bangladeshi / A3
Asian or Asian British – Other / A9
Black or Black – Caribbean / B1
Black or Black British – African / B2
Black or Black British – Other / B9
Chinese / O1
Other ethnic group / O9
Decline to declare / NS
  1. Do you have, or have you had any physical or mental impairment which would qualify you as disabled as defined in the Disability Discrimination Act 1995?

YES [ ]NO [ ]

Cambridge House is committed to best practice in the recruitment, training and retention of disabled employees. Please tell us about any adjustments you would need to enable you to compete fairly for this job/demonstrate you competency/participate fully in any training courses.

  1. Please describe any special requirements you need at work as a result of your personal circumstances.

Do you have religious requirements eg Holy Days, Festivals

Full name:Position applied for:

…………………………………………………………………………………………

FOR OFFICE USE ONLY

Shortlisted:YES [ ]NO [ ]

Selected for appointment:YES [ ]NO[ ]