A Charity Registered in Scotland, No: SC005776
Company No: 212157
Application for Employment
Candidate No:
Post Applied For:
Important Notes:
Returning your application.
We do NOT accept CVs. We do NOT accept
faxed applications.
E-mailed applications should be sent to:
[email protected]
The section of the form containing personal details
will be detached from the rest of the application and
that information will not be available to the
shortlisting panel.
Postal applications should be sent to:
Janette Kerr, Administrator, West Lothian Drug &
Alcohol Service, Floor 1, The Almondbank Centre,
Shiel Walk, Livingston, EH54 5EH
If the form is not completed and submitted online,
please complete it in black ink using BLOCK
CAPITALS.
PERSONAL DETAILS
Surname:
Initials:
Address:
Phone No (day):
Phone No (evening):
Candidate No:
EDUCATION AND TRAINING
(Please continue on a separate sheet if required)
Secondary Education
Certificates gained
Subjects/Modules
Grades/Bands
Further and Higher Education
Where attended
Course
(show full or part-time)
Qualification and date
gained
Provided by
Duration
Class of Membership
Date obtained
Other Training
Name of course
Professional Qualifications
Name of Professional Body
Candidate No:
EMPLOYMENT HISTORY
(Please continue on a separate sheet if required)
Employer’s name, address &
business
Dates
From
To
Job title and summary of main duties
and responsibilities
Candidate No:
HEALTH/MEDICAL INFORMATION
Do you have, or have you had, any recurring health problems, which are likely to affect
your ability to fulfil the requirements of this post?
YES 
NO 
If yes, please give details……………………………………………………………………………..….
………………………………………………………………………………………………………….……..
………………………………………………………………………………………………………….……..
Applications from disabled candidates are welcomed and the organisation will make every
effort to ensure a fair selection process.
Please describe below any reasonable adjustments which you feel should be made to the
recruitment process to assist your application for the job/attend for interview:
……………………………………………………………………………..………………………………….
………………………………………………………………………………………………………….……..
………………………………………………………………………………………………………….……..
Please describe below any reasonable adjustments which you feel should be made to the
job itself, if you are successful, which would enable you to carry out the duties of the job:
……………………………………………………………………………..………………………………….
………………………………………………………………………………………………………….……..
………………………………………………………………………………………………………….……..
GENERAL INFORMATION
Are you currently eligible for employment in the UK?
YES 
NO 
You will be required to provide proof of this before commencing employment.
HOBBIES AND INTERESTS
Please give details of your social interests, hobbies, sports and membership of clubs and
societies including special responsibilities:……………………………………………………………………………..………………………………….
………………………………………………………………………………………………………….……..
Candidate No:
Tell us how you match the Essential elements of the person specification citing relevant
and specific examples from your work experience.
Candidate No:
Tell us how you match the Desirable elements of the person specification citing relevant
and specific examples from your work experience.
Candidate No:
Supply other relevant details in support of your application and describe the contribution
you would make to the organisation.
REFEREES
Please give details of two referees (who are not related to you), at least one of whom is
your current or most recent employer who has direct knowledge of your work experience
and abilities. References for all candidates to be called for interview will be taken up
although current employer will only be contacted with your consent unless you are offered
the post.
Name ………………………………………………
Name ………………………………………………
Organisation ……………………………………..
Organisation ……………………………………..
Full Postal Address ……………………………..
Full Postal Address ……………………………..
………………………………………………………
………………………………………………………
………………………………………………………
………………………………………………………
Tel No. …………………………………………….
Tel No. …………………………………………….
Relationship ……………………………………..
Relationship ……………………………………...
Candidate No:
DECLARATIONS
Please read carefully
West Lothian Drug & Alcohol Service is discharging a Social Services function and is,
therefore, covered by the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 and
in this connection you are obliged to disclose ALL current and spent convictions.
Do you have any criminal convictions?
YES 
NO 
All previous convictions MUST be listed on the Conviction Declaration Form, which should
be returned, in the separate envelope provided, along with your application form. The
envelope containing the Conviction Declaration Form will only be opened if you are to be
invited for interview, otherwise the envelope will be returned to you unopened.
I certify that all information contained in this form is true and correct to the best of my
knowledge. I understand that if I am offered a post the information submitted in my
application form will form the basis of my employment with West Lothian Drug & Alcohol
Service and if it is subsequently discovered that I have wilfully given false information or
withheld information, then I will be liable to immediate dismissal.
I understand that any offer of employment will be subject to receipt of permission to work
in the UK, satisfactory references, satisfactory Disclosure Scotland results and a
probationary period.
I authorise West Lothian Drug & Alcohol Service to verify information contained in this
application via telephone, e-mail, fax or letter. I understand that third parties may be
consulted to verify qualifications, criminal convictions and health information should this
be necessary for this post.
Signature ………………………………………………………
(Please sign with initial and surname only.)
Date ……………….……………
Candidate No:
STORAGE OF SENSITIVE INFORMATION
The personal information given on this form will be treated in confidence and will not be
disclosed to any third parties except permitted by law or where consent has been given.
The information given is being gathered for internal consideration by West Lothian Drug &
Alcohol Service.
West Lothian Drug & Alcohol Service will store this Application Form in a secure and safe
manner. The information gathered on the form will be retained for no longer than is
necessary for the purposes of processing the application.
I authorise the collection of this information by West Lothian Drug & Alcohol Service so
that it may be used for the above purpose. It will be my responsibility if any information is
incomplete or incorrect. I am aware that I am able to access, according to the Data
Protection Act 1998, the information regarding my personal data that is kept by West
Lothian Drug & Alcohol Service by providing a written request. I can also request the
correction, addition or elimination of any data through this written request.
Signature ………………………………………………………
(Please sign with initial and surname only.)
Date ……………….……………
Equal
Opportunities
Monitoring Form
Position Applied for: ........................................................................................................................
Where did you see the vacancy advertised? .................................................................................
West Lothian Drug & Alcohol Service’s Equal Opportunities Policy aims to ensure that
individuals are not discriminated against on the grounds of race, colour, culture, ethnic
origin, religion, gender, disability, marital status, responsibility for dependents, sexual
orientation or age. In order to monitor the effectiveness of the policy, all job applicants are
asked to complete this form. The information will be used for monitoring purposes only.
Please complete all sections of the questionnaire below by placing a tick () or by
providing information, where appropriate, in the classification box applying to you in each
section.
GENDER AND SEXUAL ORIENTATION
Female

Male

Lesbian

Gay

Bisexual

Transgender 

Heterosexual
AGE

Under 21
22-34 
35-39 
40-49 
50-64 
65+

MARITAL STATUS
Married

Unmarried

*Other

* For example, individuals who are widowed but have not remarried, individuals who are
separated, individuals who are living with a partner.
DISABILITY
Do you consider yourself to be disabled under the Equality Act 2010, i.e. do you consider
yourself to have a long term (has lasted or is expected to last 12 months or more) physical
or mental impairment that has a substantial and adverse effect on your ability to carry out
normal day to day activities.
Please tick the appropriate box:
Disabled 
Not Disabled 
ETHNIC ORIGIN
Individuals should determine with which of the undernoted categories they most closely
associate themselves having regard to their ethnic or cultural background. These
categories are recommended by the Commission for Racial Equality.
White - British
Irish
Black – African
Black – Caribbean
Black – Other





Asian - Indian
Asian - Pakistani
Asian - Bangladeshi



Asian - Chinese
Asian - Other
Candidate No:


Conviction
Declaration
Form
Please complete this form, place in the enclosed envelope and seal.
This form will only be looked at if you are to be invited for interview. In all other cases the
form will be returned to you in the unopened envelope.
West Lothian Drug & Alcohol Service is discharging a Social Service function and is,
therefore, covered by the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975
and in this connection you are obliged to disclose ALL current and spent convictions.
Please give details of any convictions as set out below.
PERSONAL DETAILS
Surname …………………………………………. First Name…………………………….……………...
Address ……………………………………………………………………………………………………….
………………………………………………………………… Post Code …………………………………
Date of Birth ………………………………………………………………………………….......................
CRIMINAL CONVICTIONS
Please list all convictions in date order starting with the earliest.
Nature of the offence
Date of
sentencing
Nature and length of sentence
Do you wish to comment on any of the above? (Use a separate sheet if necessary)
Personnel/App form V.E (2013)
Candidate No: