Worcester action for youth (CIO)
Position applied for
Manager
PERSONAL DETAILS
First name
Surname
Address
Telephone
Mobile
Post code
Date of birth
Nat Ins No.
Email
Education
School, College, University
Qualification
and Grade
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Date
obtained
Worcester action for youth (CIO)
Ongoing Professional Development
Qualification
and Grade
Date
obtained
Training
Please use the space below to give details of any training or non-qualification
based development which is relevant to the post and supports your application.
Training Course
Course Details
(including length of course/nature of
training)
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Worcester action for youth (CIO)
EMPLOYMENT HISTORY
Employer/Organisation
(most recent first)
Position held and brief
description of
duties/responsibilities
Dates
From - To
Reasons for leaving
and final salary
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Worcester action for youth (CIO)
MEDICAL HISTORY
Give a brief outline of any health problems or disabilities.
Do you hold a current, valid full driving licence?
Yes / No
Do you have use of a car? Yes/ No
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Worcester action for youth (CIO)
NAMES AND ADDRESSES OF TWO REFEREES
(One must be a previous employer and it is preferable if the other is someone who has
knowledge of any work or volunteering previously done with children and young
people.)
Employers’ Name
Name
Address
Address
Tel no.
Tel no.
Email:
Email:
Job title
Job title
Relationship to You:
Relationship to you:
Do you wish to be consulted before these referees are approached?
Yes / No
Date you could start employment.
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Worcester action for youth (CIO)
Because the work involves contact with children and young people you are
required by the Rehabilitation of Offenders Act 1974 to declare all convictions,
including spent convictions. Please sign one of the following statements as
applicable.
1.
I declare that I have no criminal convictions for offences involving children
and/or young people and any unspent criminal convictions for any offence
involving dishonesty, deception or assault against a person.
Signed: ……………………………………..………………
2.
If short listed I will provide a list of all convictions in a separate sealed
envelope to the Manager.
Signed: ……………………………………..………………
Having a conviction will not necessarily prevent you from working for Worcester
Action for Youth (CIO).
I consent to a DBS check if this is required and agree to abide by the relevant
policies and procedures. By signing this form, I agree to the details recorded
here being held on computer by the Charity.
I understand that if any information I have provided is found to be untrue any
offer may be withdrawn or any contract of Employment may be terminated.
Signed: ................................................................ Date: ...........................
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Worcester action for youth (CIO)
Additional information
Experience, Skills and Knowledge
Please use this section to demonstrate why you think you would be suitable for
the post by reference to the job description and person specification.
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]
Worcester action for youth (CIO)
How did you hear about the post?
Are you available for interview on 5th July 2017?
Yes ….No
Declaration
Statement to be Signed by the Applicant
Please complete the following declaration and sign it in the appropriate place
below. If returning by email, you will be requested to sign it at interview.
I agree that Worcester Action for Youth (CIO) can create and maintain
computer and paper records of my personal data and that this will be
processed and stored in accordance with the Data Protection Act 1998.
I confirm that all the information given by me on this form is correct and
accurate and I understand that if any of the information I have provided is
later found to be false or misleading, any offer of employment may be
withdrawn or employment terminated.
Signed:
Date:
Worcester Action for Youth (CIO)
Charity No: 1169888
Tel: (01905) 350550 email: [email protected]