Ref: XXXXXX

CONFIDENTIAL

Application for the Post of: XXXXXXXXXXXXXXXX

Please complete this form in black ink or type. Email applications are preferred.

Please refer to the Job Description and Person Specification; they will help you decide what information is relevant to your application.

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1. PERSONAL INFORMATION

Name:

Address:

Daytime Telephone Number:

Mobile Number:

Email:

___________________________________________________________________________

2. ATTENDANCE

Please state your total unplanned days off work in the past two years, whether due to illness, attendance at a health-related appointment, compassionate leave, or other reason:

Number of Days:

Reasons:

___________________________________________________________________________

3. REFERENCES

Please give the name, address, telephone number and email address of two referees. One referee should preferably be your most recent employer. We will not contact your referees without checking with you first.

1.

2.

_________________________________________________________________________

4. Where did you see this job advertised, or how did you hear of it?

___________________________________________________________________________

5. If offered the post, when would you be able to start work?

6. EDUCATION & TRAINING

School or College	Examinations taken and results (if any)	Date

Any other training

Please provide brief details of recent training and approximate dates.

7. WORK HISTORY, PAID OR UNPAID

£

What is your current or most recent salary?

Please list your recent work history, including regular voluntary work.

From – To	Employer's name and address	Post held and main duties	Full or part time	Reason for leaving

8. APPLICANTS WITH DISABILITIES

If you have a disabilty due to a physical, sensory or visual impairment, please indicate below if you would need any special arrangements or assistance because of this. Please state carefully what particular requirements you may have, whether at the interview stage or, if you were offered the post, in the performance of the duties of the job.

9. EXPERIENCE, SKILLS AND ABILITIES

In this space please briefly list 3 key strengths in your past experience, skills and/or abilities that make you suitable for this post (no more than 100 words).

10. REASONS FOR APPLYING

Please explain why you are interested in this job (no more than 100 words).

11. PERSONAL STATEMENT

Please address the Person Specifcation and explain, giving examples, of how you meet the requirements for the post (no more than 1000 words or 2 x A4 pages)

12. CRIMINAL CONVICTIONS

All staff who are employed by Age UK Islington are recruited reflecting the current legislation relevant to Safeguarding and the list of roles eligible for Disclosure and Barring checks.

The Safeguarding Vulnerable Groups Act 2006 set out the scope and operation of the vetting and barring scheme. The Criminal Records Bureau was established under Part V of the Police Act 1997. Part 5 of the Protection of Freedoms Act 2012 covers the reduction in scope of the definition of regulated activity, new services provided by the DBS, and disregarding convictions and cautions for consensual gay sex.

If invited for interview you will be asked to complete a separate disclosure form. You should seal this in an envelope marked with your name and the application reference code (at top right of the first page of this application form) and hand it to the interviewing manager.

Past criminal proceedings are seldom an obstacle to taking up a post. This occurs only where the offence/s is/are deemed relevant. But honest disclosure is essential: failure to disclose any past convictions, cautions, etc, would disqualify you from holding the post.

13. DECLARATIONS

I declare that the information provided on this application form and all other information provided in support of my application is true and complete to the best of my knowledge and belief.

I understand that any false or omitted information may result in failure to appoint, or in dismissal or other disciplinary action if I am appointed.

Signed:………………………… Date: ………………..

By sending a completed application to us by email, you are ‘signing’ this application and endorsing the declarations above.