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Application Form

The document is an application form for a job vacancy, requiring personal details, employment history, qualifications, and legal eligibility to work in the UK. It includes sections on criminal record disclosure and a data protection statement regarding the use of provided information. Applicants must sign a declaration certifying the accuracy of their information and consent to background checks.

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27 views4 pages

Application Form

The document is an application form for a job vacancy, requiring personal details, employment history, qualifications, and legal eligibility to work in the UK. It includes sections on criminal record disclosure and a data protection statement regarding the use of provided information. Applicants must sign a declaration certifying the accuracy of their information and consent to background checks.

Uploaded by

yhqfpjyh6q
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Application Form

Vacancy Applied for:

Hours Applying for:

Where did you hear about this vacancy?

PERSONAL DETAILS
Title: First Name: Surname:

National Insurance Number:

Address: Contact Numbers

Home:

Mobile:
Postcode:
Personal Email Address:

Do you hold a valid UK driver licence? Yes No

Own Transport? Yes No

LEGAL RIGHT TO WORK IN THE UK


Do you have the right to work in the UK? Yes No

Which option is your eligibility to work in the UK based upon?

UK/ROI Passport Citizenship EEA/European National

Indefinite leave to remain Tier 1 Visa Tier 2 Visa

Other Visa – Please Specify

1
EMPLOYMENT/EDUCATIONAL HISTORY
Please provide details of the HR department or referencing department at your present or most recent
employment (or last educational establishment if applying direct from further education). Any omission may
delay the referencing procedure and your date of commencement if your application is successful. Please
provide:
 Full contact and address details (email if possible) for all previous employment and/or education
including all agencies you may have worked for from the age of 16.
 Provide full details and explanations for all gaps in employment history
 Please confirm your consent to approach your current employer for a reference by ticking here

Employer/Education/ Position Held Dates Employed Address/email/ Reason for


Agency Telephone Number leaving
Most recent first Official job title From To Please provide address
month/year Month/year details for HR department

Telephone:
Email Address:

Telephone:
Email Address:

Telephone:
Email Address:

Telephone:
Email Address:

Telephone:
Email Address:

2
Telephone:
Email Address:

Telephone:
Email Address:

Telephone:
Email Address:

Telephone:
Email Address:

QUALIFICATIONS e.g NVQ

Date attended from and University/College/School Subject Grade


to

MEMBERSHIP OF PROFESSIONAL ORGANISATIONS

Dates of Membership Organisation Grade of Membership

3
CRIMINAL RECORD
It is the organisation’s policy that all applicants are required to complete a self-declaration form in addition to
an Enhanced Criminal Records Bureau Disclosure to protect vulnerable adults and children

Do you have any convictions, cautions and other sanctions, including those spent under the provisions of
the Rehabilitation of Offenders Act 1974?
Yes No

If yes, please provide details……………………………………………………………………………………......

………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………….

Are you, or have you ever been, known to any Social Work Department/Social Services Department (in
England and Wales) as an actual or potential risk to vulnerable adults or children?
Yes No

If yes, please provide details……………………………………………………………………………………......

………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………….

DATA PROTECTION STATEMENT


The information you are providing will be used by Autism West Midlands in connection with your
application and for assessing your suitability for the post advertised. The information will be shared only in
compliance with the law and for the purpose of monitoring the charity’s practices to ensure equality of
opportunity and will be treated confidentially. If you are successful this information will be transferred onto
our HR system.
DECLARATION
Given the nature of the job to which I have applied, I understand that any offer of employment will be
subject to completing a DBS check from the disclosure and barring service. I declare that the information
given in this form is complete and accurate. I understand that any false information or deliberate
omissions will disqualify me from employment or may render me liable to summary dismissal. I
understand these details will be held in confidence by the organisation, for the purposes of assessing this
application, ongoing personnel administration and payroll administration in compliance with the Data
Protection Act 1998
DISCLAIMER AND SIGNATURE
 I certify that my answers are true and complete to the best of my knowledge
 If this application leads to employment, I understand that false or misleading information in my
application or interview may result in the withdrawal of an offer or dismissal if already employed
 I understand that my application will be subject to employment referencing and consent to
enquiries being made for this purpose
Signature: Date:

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