Please Complete This Application Form in Black Ink Or Type

Please Complete This Application Form in Black Ink Or Type

Application Form

Please complete this Application Form in black ink or type.

Position applied for / Reference: (For office use only)

EDUCATION – Please give details of education and qualifications

Please give details of other courses attended and qualifications, if any achieved


Please give any details of jobs you have held starting with your present or most recent employer and work backwards in chronological order. Include in this section any breaks in employment history for example carer responsibilities, travel study, registered unemployment and temporary/voluntary employment.

Employers Name and period of employment / Position Held / Responsibilities and duties / Notice required/ Reason for leaving

Additional Information

Please note the selection criteria for this job which will be used to assess your application.

Describe below why you have applied for this position and set out your relevant experience, knowledge, skills and abilities.

For this section you can use additional sheets of A4 paper.

Please give details of any voluntary organisations, committees, council or professional bodies with which you are involved


Please give details of two people (not relatives) that we could approach for references. One of your referees should be your current or most recent employer. Please ensure that you have obtained their permission to do so. By completing this section we will assume that you have given these referees permission to disclose information about you to us.

Referees will only be contacted for successful candidates

Job Title
Tel no.
Capacity in which you are known to the referee
Email / Name
Job Title
Tel no.
Capacity in which you are known to the referee

Do you agree to your referees being contacted if an offer of employment is to be made? Yes No


The Copleston Centre is committed to maintaining privacy of all its staff and customers. It expects all staff to handle all individuals’ personal information in a sensitive and professional manner. All staff are under an obligation not to gain access or attempt to gain access to information they are not authorised to have

Equal opportunities

The Copleston Centre has a strong commitment to achieving equality of opportunity and expects all employees to implement and promote its policy in their own work.

Rehabilitation of Offenders Act 1974

This post is exempt under the Rehabilitation of Offenders Act 1974. You are therefore required to declare any existing or pending prosecutions, convictions, cautions, reprimands or final warnings you may have, even if they would otherwise be regarded as “spent” under the Act. Failures to declare a conviction, caution, reprimand or final warning may, however disqualify you from appointment, or result in dismissal if the discrepancy comes to light


Last Name: (Mr, Mrs Miss Ms Other) / First Name:
Address: / Home Telephone no:
How did you find out about this post?
Newspaper advert (please specify which newspaper)
Word of mouth
Other (please specify)


All of this application form apart from the equal opportunities monitoring form will be retained by the Copleston Centre for a maximum of six months, unless you are the successful applicant for the post, in which case the application form will become part of your employee record. Some of the data you provide is considered to be Sensitive Personal Data under the Data Protection Act i.e gender and race. This information will be used to assist us with recruitment monitoring. It will be held separately from application forms. It will also be held in computer format.

By signing this form you are giving consent for the Copleston Centre to use this data in the way described above.

I confirm that the information I have given in this form is correct and complete and that misleading statements may be sufficient for cancelling any agreements made. I confirm I am not subject to immigration control (Immigration, Asylum and Nationality Act 2006)

Signed...... Dated......

Copleston Centre

Copleston Road, SE15 4AN

020 7732 3435

Charity Number: 1116694