IN CONFIDENCE

RELATIVE RESPONSE TEAM Application Form

Please complete and use the back of the form if you require space for extra information

PERSONAL DETAILS

Full name
Address (include postcode)
Home Tel. No.
Mobile Tel. No.
E-mail
National Insurance Number
Nationality (If you are not a British passport holder or a European Citizen, or you do not have the permanent right to remain in the UK, you will require a work permit.)
Do you require a work permit to work in the UK? / Yes No
If you already have a work permit, when does it expire?
(Please note that your current work permit may not be valid for this post.)
Do you have any convictions NOT spent under the rehabilitation of offenders Act 1974? / Yes No
EDUCATION, TRAINING AND PROFESSIONAL QUALIFICATIONS
(Original documents as proof of qualification will be required at interview.)
RELEVANT EXPERIENCE
For example, telephony response work (including recording of information), uniformed/emergency services, dealing with the media, IT skills, counselling for bereaved relatives, oil and gas, energy sector industry, foreign language skills.
CURRENT EMPLOYMENT
Please include company name, address, date commenced, description of duties, work pattern and any out of hours commitments
PREVIOUS EMPLOYMENT
Please include company name, address, date commenced and date left, description of duties, reason for leaving
PATTERN OF AVAILABILITY
Please indicate which time periods you may be interested in covering (please “tick” a box if you are available, place a “?” if you might be, and an “x” if you are unavailable.
6
am / 7 / 8 / 9 / 10 / 11 / 12 / 1
pm / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 1
am / 2 / 3 / 4 / 5
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Does this availability pattern have any seasonal variations, e.g. school holidays? If so, please provide details.
Do you have any call-out type commitments, e.g. Reserve Forces, First Responder, Mountain Rescue, Fire Service? If so, please provide details (such as name of organisation, responsibility within the organisation, nature of call-out commitment)
PERSONAL INTERESTS What activities outside work interest you? State any positions held you consider relevant.
What interests you in this employment opportunity?
How did you find out about this employment opportunity?
REFERENCES Title, full name, address, phone number, email, relationship to you.
(Please do not use relatives, partners or friends as referees.)
Referee 1
Referee 2
DECLARATION Please sign this declaration
I declare that the information given in this application form is true and complete. I understand that if I have given any misleading information on this form or made any omissions, this will be sufficient grounds for terminating my employment.
Signed: / Date:

The information provided by you on this form as an applicant will be stored either on paper records or a computer system in accordance with the Data Protection Act 1998 and will be processed solely in connection with recruitment.

Please email this form, along with your CV, to . Closing date: 10th April, 2017

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