Job Application Form Fields marked with an * are required Vacancy Applied For Vacancy Reference Number PERSONAL DETAILS Surname Preferred Title Forenames Email Address Address Town/City County Postcode Contact Address (if different) Do you hold a full clean driving licence valid in the UK? Yes No Are you required to have a visa or work permit to be employed in the UK? Yes No If yes, please give details including expiry date of any visa/permit Tel. No. (Home) Tel. No. (Mobile) Where did you see this vacancy advertised? CRIMINAL CONVICTIONS Rehabilitation of offenders act 1974 Have you ever been convicted of a criminal offence or do you have any pending criminal charges? Yes No If yes, please submit details below. Only relevant convictions will be taken into account, therefore disclosure need not necessarily be a bar to obtaining this position. In the event of a successful application you will be required to undergo a Disclosure and Barring Service (DBS) Enhanced Disclosure check. Criminal Conviction Details EDUCATION (Secondary Education Onwards) 1. Name of School / Training Body 1. Subject Studied 1. Qualification and Grade 2. Name of School / Training Body 2. Subject Studied 2. Qualification and Grade 3. Name of School / Training Body 3. Subject Studied 3. Qualification and Grade TRAINING COURSES Please give details of any training which is relevant to the post and supports your application. Include any internal training as well as formal courses Training Course 1 Date Obtained Training Course 2 Date Obtained PROFESSIONAL ASSOCIATION MEMBERSHIP 1. Name of Institute 1. Current Status 1. Date Awarded 2. Name of Institute 2. Current Status 2. Date Awarded 3. Name of Institute 3. Current Status 3. Date Awarded EMPLOYMENT HISTORY 1. Current / most recent employer / organisation Name of Employer Address Position Held From To Brief description of duties Reason for leaving / changing? Notice period? (if current) 2. Employer / Organisation Name of Employer Address Position Held From To Brief description of duties Reason for leaving / changing? 3. Employer / Organisation Name of Employer Address Position Held From To Brief description of duties Reason for leaving / changing? SUPPORTING STATEMENT Please state why you wish to be considered for this post, include any relevant skills, experience and training that support your application. (No word count limit. You may wish to copy and paste from a Word document.) Supporting Statement REFERENCES Please give details (including email address) of two employment referees whom we can approach for a reference. One of them should be your current (most recent) employer or your educational establishment. If you are unable to supply two employment references please clearly outline who your referees are. Name Position Organisation Address Email Tel. No Capacity in which known by you May we contact this referee prior to interview? Yes No Reference 2 Name Position Organisation Address Email Tel. No Capacity in which known by you May we contact this referee prior to interview? Yes No CONFIRMATION I consent to the information provided on my application being stored on a manual and/or computerised filing system in accordance with the Data Protection Act By submitting this application form you consent to The Nelson Trust using and retaining information about you provided by you – or third parties such as referees – relating to your application or future employment. This information will be used solely in the recruitment process and will be retained for six months from the date on which you are informed whether you have been invited to interview, or six months from the date of interview. Such information may include details related to ethnic monitoring and disability; these will be used solely for internal monitoring and will not be disclosed to any third party. The Nelson Trust commits to only processing necessary data that is targeted and proportionate to achieve its lawful and legitimate purpose of providing services that benefit society. All individuals have the right of access, rectification, the right to object and the right of erasure as well as the right to restrict processing. I Consent I confirm that to the best of my knowledge the information I have provided on this form is true and accurate. I understand that if the information I have supplied is false or misleading in any way, it will automatically disqualify me from appointment or may render me liable to dismissal without notice. I Confirm Submit
