Job Application form

Section A: Application for Employment

Post details

Application for the post of:
Department:
Closing date:

Personal

Title:
First name:
Last name:
Address:
Town/City:
County:
Postcode:
Phone:
Mobile:
Email:
National insurance no:
Date of birth:
Are you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) national?
Please tick the category that relates to your current immigration status.This status will be subject to checking before interview.
Do you have a legal right to work in the UK?
Do you have a work permit?
Please state details:

References

Please give the names and addresses of TWO referees (not relatives) whom we may contact. One of these should be your current or last employer if you have been employed recently. We will not contact your current employer without your permission.
Please note: references will be requested following interview.

First referee

Reference:
Name:
Job title:
Address:
Postcode:
Phone:
Email:

Second referee

Reference:
Name:
Job title:
Address:
Postcode:
Phone:
Email:

Rehabilitation of Offenders Act 1974

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198'.
Please give details:

Section B: Application for Employment

Education and training

Type:
Name:
*
From:
To:
Qualifications gained with grades:
*
Date gained:

Membership to professional bodies

Include in this section any relevant professional registrations or memberships. If you are applying for a post that requires professional registration, you are required to provide the following information.

Body:
Membership No:
Expiry date:(optional)

Employment History - Current or most recent employer

Current/Most Recent Post Held:
Name of Current/Most Recent Employer:
Address of Current/Most Recent Employer:
Postcode:
Job title:
Date started:
*
Salary:
Notice required:
Reason for leaving (if applicable):

Full employment history, explaining any gaps in employment

Post held:
*
Name of employer:
*
Address of employer:
*
Postcode:
*
From:
*
To:
*
Reason for leaving (if applicable):

Supporting evidence

In support of your application, please give evidence detailing how you meet the requirements of the job and the knowledge, skills and abilities as detailed in the Person Specification. You should also give relevant examples to support any assertions.

Please restrict your answer to no more than 2000 words


Section C: Equal Opportunities Form

Pendleside Hospice is required to collect Equal Opportunities information. This information is for monitoring purposes only and will help the organisation analyse the profile and make up of applicants and appointees to jobs. This section is not made available to the panel at any point during the process.

The Hospice recognises and actively promotes the benefits of a diverse workforce and is committed to treating all employees with dignity and respect regardless of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. We therefore welcome applications from all sections of the community.

I would describe my ethnic origin as follows:
Please indicate your gender:
Please select the option which best suits your sexuality:
Please indicate your religion or belief:

The Equality Act 2010 protects disabled people – including those with long term health conditions, learning disabilities and so called “hidden” disabilities such as dyslexia. If you feel that you have a disability we will make reasonable adjustments to ensure that the selection process is fair and equitable. Please contact us to arrange any support which will help you in the selection process.

Do you consider yourself to have a disability?

If applicable, please state the type of impairment which applies to you. People may experience more than one type of impairment, in which case you may indicate more than one. If none of these categories apply, please mark “Other” .

Declaration

*
Where did you see this vacancy advertised?
Please give details:
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