Application for Employment This front sheet will be removed prior to the shortlisting process. Please type or print clearly in black ink and complete every section. Please note CV’s will not be accepted Position applied for: Closing date for application: (Mr/Mrs/Miss/Ms/Dr/Other) Title: Surname/Family Name: Forename(s): Home Address: Postcode: Home Tel. No.: Mobile Tel. No.: Are you happy for us to contact you at work if necessary? Work Tel. No.: Yes □ No □ Email Address: Candidate No. For office use only 1 Recruitment and Selection Monitoring In order to ensure that Amber Trust’s equal opportunity policies are effective, it is important to collect information on the age, gender and race of all applicants. Your assistance in completing this section is greatly appreciated as it helps us to improve our policies and practices. This form will be separated from your application before shortlisting and used only for monitoring purposes. Thank you. ETHNICITY White British  Other Mixed background  Black Caribbean  White Irish  Indian  Black African  White Other  Pakistani  Other Black background  White & Black Caribbean  Bangladeshi  Chinese  White & Black African  Other Asian background  Any Other  White & Asian Please state _________  GENDER Date of Birth Are you DD/MM/YY Female  Male  ___/___/___ Signature: ……………………………………………….. 2 Date: ………………… Candidate No. Position applied for For office use only Education and Training (Please state the most recent educational experience first) School/College/University Course Title or Subjects Studied (Incl. Level, eg. Degree, Diplomas, etc. Other Training: (List if relevant to the vacancy for which you are applying) Course Organising Body 3 Grade/Class Current or most recent employment Current/Most Recent Employment: Name of Employer: Address: Job Title: Current/Most recent salary: Dates of Employment: From: Period of notice required: Reason for seeking alternative employment: Brief description of duties/responsibilities and achievements: 4 To: (weeks) Employment History (Please start with the most recent and include full time, part time and voluntary work. Please account for any gaps in your employment history giving relevant dates) Previous Employment: Dates Job Title Employers name & address Reason for leaving References (One reference should be your current or most recent employer) First Referee Second Referee Name: Position: Organisation And Address: Tel. No.: Relationship: □ Please tick the boxes if you do not wish the referees to be contacted prior to interview. 5 □ Disclosure of Criminal Record The Trustees of Amber Trust are obliged by law to operate a checking procedure for employees who have access to vulnerable people. Under the terms of the Rehabilitation of Offenders Act 1974 (Exemptions) and (Amendment) Order 1986 there are occasions where convictions, although normally ‘spent’ can be taken into account. Because of the nature of the role Amber Trust undertakes, caring for some of societies most vulnerable people, you must disclose any conviction, action, binding over or caution, or any pending court appearance and include all spent convictions. If you fail to disclose such convictions or pending court appearances and are appointed, then this could result in dismissal or disciplinary action by Amber Trust. Information provided in the section will be discussed with the candidate only if the matter is considered relevant to the post. In the event of a successful application, a disclosure will be sought from the Disclosure and Barring Service. A conviction would not necessarily be a bar to obtaining employment. Declaration (please delete as appropriate) I confirm that I do/do not have any convictions, actions, binding over’s or cautions, or any pending court appearances about which I should inform Amber Trust in confidence. Signature: Date: Your Experience and Skills Please describe very clearly how your previous experience, skills and achievements demonstrate your ability to do this job and relate the details to the Person Specification. Please refer very carefully to the Job Description and Person Specification before completing this part of the form, then tell us how you feel you meet the requirements of the post. Include why you are applying for this post. Short listing will be based on the evidence you provide of your ability to meet the selection criteria for this post. Continue on a separate sheet(s) if necessary. 6 Please enter any further information you consider relevant to your application: Do you hold a current driving licence? Yes/No Do you have any current endorsements? Yes/No If yes, please give details: Do you have use of a car during working hours? Where did you see this post advertised? Leisure Interests Please give details of your hobbies and interests: 7 Yes/No Confirmation I confirm that the information contained in this application form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered that any statement I have made is false and misleading then I may be dismissed from my employment within the company. Signed: Date: Instructions 1. The completed application form should be marked ‘Private & Confidential’ and returned to: Tracy Litchfield, Amber Trust, 7-11 Wellington Street, Ripley, Derbyshire, DE5 3EH. If you wish to return via email, please send to [email protected] 2. Any form of canvassing will disqualify the candidate. 3. Candidates selected for interview will be notified as soon as possible after the closing date. 8