Application Form: Ynot Aspire Ltd.
Title of position/role applied for:
Job Reference Number:
SECTION A: Personal Details
1. about you
Surname:
Forename(s):
Title (e.g. Mr, Miss,
Ms, Mrs, Dr):
Current Address:
Postcode:
Email Address (if
applicable):
Home Telephone
Number:
Mobile Telephone
Number:
Do you have a driving
license?
Please provide the
name of someone
would should contact
for you in the event of
an emergency:
Yes ☐
No ☐
Emergency Contact
telephone number:
Relationship to you
(e.g. Mother, Father,
Guardian, spouse):
2. Employment History
Current/last
employer’s name
Position held
Dates:
Reason for leaving:
Brief outline of
duties:
From:
To:
Previous employment (Most recent first):
Name and Address of
Position held
From:
To:
previous employer
Brief description of
duties:
Voluntary or unpaid work:
Please tell us about any voluntary or unpaid work you are doing now, or that you
have done in the past
Name and Address of
Position held
From:
organisations for whom
To:
Brief description of
duties
you have volunteered
3. Qualifications
Only complete this section if you have qualifications that are relevant to the post.
You should include details of any relevant overseas qualifications. Please note that
original certificates may need to be produced.
School/College/University
From:
To:
Qualifications gained
Level and
grade
4. Availability
Please indicate when you would be
☐
Daytime
available (Please mark all that apply)
☐
Weekends
☐ School Holidays
☐
Evenings
☐ Weekdays
☐ Term time
How much time can you give each
week?
5. Supporting statement
This supporting statement gives you an opportunity to tell us more about yourself
and your suitability for the role. Please tell us how you meet the
requirements listed in the person specification and your suitability
for the role. Please tell us how you meet the requirements listed in the person
specification and your reasons for wishing to become a Mentor. Please continue on
a separate sheet if necessary.
6. References
Please provide the names of two referees. If you are (or have
recently been) employed in either a paid or unpaid capacity, one
should be available one should be from your current or last employer. If you are a
student, one should be a senior staff member from your place of study. If you have
not been previously employed, a suitable character reference must be used.
The post you are applying for involves work with vulnerable groups, including
children and young people. If you have worked in these sectors previously, one
referee must be able to comment on your suitability to work with these groups.
References will only be taken if you are invited for interview. Appointment will be on
receipt of satisfactory references.
Referee 1:
Referee 2:
Name:
Name:
Position held:
Position held:
Organisation:
Organisation:
Address:
Address:
Relationship to you:
Relationship to you:
Telephone Number:
Telephone Number:
Email:
Email:
SECTION B: Declaration
Health
All successful candidates are required to complete a pre-employment medical
questionnaire before appointment.
Disclosure and Barring Service (DBS) checks.
All posts involving work with vulnerable groups, including children, will require a
Disclosure and Barring Service (DBS) check. Having a criminal record will not
necessarily bar you from working with us. This will depend on the nature of the
position and the circumstances and background of your offenses.
Under the Rehabilitation of Offenders Act 1974, you only have to declare unspent
convictions. However, if the post for which you are applying is one which is an
exception under this Act and is eligible, we will ask anyone who is provisionally
offered a position/role for an up-to-date criminal record check from the DBS, which
may provide information about convictions, cautions, reprimands and final warnings
which might otherwise be regarded as spent. If this is the case, it will be clearly
indicated in the advertisement and job description.
Self Disclosure of Criminal Record Information
Do you have any spent, unspent convictions, cautions, reprimands
☐Yes
☐No
or warnings?
If the answer to the question is “Yes”, please provide details of offenses, penalties,
dates and the country in which they occurred, or of allegations made against you, in
a sealed envelope marked with your name, the post name and the job reference
number. Attach this to your completed application form.
Date
Offence
Court
Outcome
Your right to work in the UK
We have a legal obligation to check that individuals have a right to work in the UK
before we employ them. Please confirm that you have a right to work in the UK and
that you have documentary evidence for this (either a British Passport or Visa). You
will be asked to bring this with you if you are called for interview.
I confirm that I have a right to work in the UK and that I have
☐Yes
☐No
documentary evidence for this
Access requirements for applicants with a disability
We will take all reasonable steps to remove any barriers you may otherwise face
when attending interview.
Do you have any access requirements that we need to be
aware of if you are invited for interview?
DECLARATION
☐Yes
☐No
I confirm that all the details I have provided in this application
form are correct, and that I have not deliberately withheld any
relevant information.
I understand that deliberately providing false information, failing to disclose relevant
information, or attempting to influence the recruitment process unfairly may lead to
my application being rejected, any offer of employment (whether paid or unpaid)
withdrawn, or actual employment (whether paid or unpaid) being terminated;
I note that the information provided on this application form may be held, further
processed or verified in accordance with the Data Protection Act 1998
Signature:
Date:
Equal Opportunities Questionnaire
Please could you respond to this information request positively as it will help us to
ensure that our policies, procedures and practices do not inadvertently discriminate
against you because of your ethnicity, disability, gender, sexual orientation, age or
religion and belief.
ETHNICITY
How would you describe yourself?
Asian or Asian British
 Bangladeshi
 Indian
 Pakistani
 Any other please write here
Black or Black British
 African
 Caribbean
 Any other, please write here
Chinese or other ethnic group
 Chinese
 Any other, please write here
Mixed heritage




White







White and Asian
White and Black African
White and Black Caribbean
Any other, please write here
British
Irish
Scottish
Welsh
Traveller
Any other, please write here
Prefer not to say
GENDER
Would you describe yourself as:
□ Male
 Female
 transgender
 Prefer not to say
Is this the gender identity the same as the gender you were assigned at birth
 Yes
 No
SEXUAL ORIENTATION
What is your sexual orientation?
 Bisexual
 Gay man
 Gay woman/Lesbian
□ Heterosexual/straight
 Other
 Prefer not to say
AGE
What is your date of birth?
RELIGION AND BELIEF
Please tick the box which best describes you:
 Buddhist
 Christian
 Hindu
 Jew
 Muslim
 Sikh
 Other religion or belief (please state)
□ No religion
 Prefer not to say
Thank you for your time, this information will only be used to monitoring the accessibility of our services and to ensure continuous improvement.
Returning this application form:
Please return this application and declaration form to:
Ynot Aspire Ltd
Hyndburn Voluntary and Community Resource Centre
St James Old School
Cannon Street
Accrington
BB5 2ER
Or email: [email protected]