Post Applied For:       Reference No:      

Location:      

Preferred Title (Mr, Miss, Mrs, etc.): Surname:

First Name (s):

Address:       Home/Work Tel:     

Mobile Tel No.:     

Post Code:      

Education and Training

Schools,Colleges,University, etc. Dates From - To Qualifications gained                 

Other training and courses attended both in and outside work with qualifications or membership of professional bodies, etc.:

Dates

     

Registered Address : 33 East Street, Havant, Hants, PO9 1AA. I & P Registration Number 29937R

A member of The Guinness Partnership

Current employmentEmployer’s name, address and nature of business

Post held and brief outline of duties

Salary, reason for leaving and notice required

DatesFrom - To

                       

Previous employment (Please start with the most recent)

Employer’s name, address and nature of business

Post held and brief outline of duties

Salary, reason for leaving and notice required

DatesFrom - To

                       

Please demonstrate below how your skills and expertise meet at least the essential requirements for the post youhave applied for. In doing this you should consider the categories and requirements outlined on the enclosed Person Specification:

~ Education Standard ~ Experience ~ Skills & Knowledge~ Physical Requirements ~ Any other requirements or details you feel may be relevant

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

(Continue on a separate sheet of paper if necessary.)

1. Do you hold a current driving licence? Yes / No     

If you have any endorsements please provide details                                                        

2. Do you require a work permit to work in the UK? Yes / No     

If yes please provide details                

3. Have you ever held or applied for a post with the Guinness Trust?

                    

If yes please give details, with dates                

Under Schedule 1 of the Housing Act (1996) we are obliged to obtain Board Authorisation should you berelated to any member of Guinness Care and Support staff or a Board Member. If this is the case please provide us with their name and the nature of the relationship.

                                                            

Please give names, current addresses and telephone numbers of at least two referees. One of these must be your current employer and together they should cover the last two years of your employment.

1.                                                                                 

2.                                                                                                                              

Tel:       Tel:      

Relationship to Referee (eg. past employer, colleague, etc.)           

*Please note references will only be taken up with your permission. If you are appointed, references will be kept on your personal file.

I understand that failing to provide relevant information or providing false or inaccurate information could (if I am appointed) lead to disciplinary action or dismissal.

I give consent for Personal Data divulged in applications and forms for employment to be kept on files (both manual and computer) for recruitment, monitoring and employment purposes. Information will be stored securely in line with the Data Protection Act 1998.

                                                                                                                                                      Signed:       Date:      

A member of The Guinness PartnershipFurther information can be found on www.guinnesstrust.org.uk

Equal Opportunities

Ref. No:            Post:           

Name:                     

Guinness Care and Support has committed itself to an Equality & Diversity Policy. This means that all job applicationswill be considered on their merits, without regard to the race, colour or national origin of the applicant, their religious beliefs, sex, age, sexual orientation or disability.

We do however need to show that we are implementing this policy. We would therefore ask you to give us someindication of how you would describe your ethnic origin. This information will be used on a statistical basis only (ie. we will keep a record of the number of applicants from various ethnic groups for each post advertised). It is totally confidential and will be considered separately from your application. If you are appointed, the information will be used throughout your employment on a statistical basis only.

What is your religion?

None Christian Buddhist Hindu Jewish

Muslim Sikh Other Do not wish to answer

What is your ethnic group?

White: British White: Irish White: Other Mixed: White & Black Caribbean

Mixed: White & Black African Mixed: White & Asian Mixed: Other Chinese

Asian/Asian British: Indian Asian/Asian British: Pakistani Asian/Asian British: Bangladeshi

Asian/Asian British: Other Black/Black British: Caribbean Black/Black British: African

Black/Black British: Other Do not wish to answer Other (please specify)

What is your sexual orientation?

Heterosexual Gay or Lesbian Bi-sexual Other Do not wish to answer

Gender: Male Female Date of Birth: Nationality:

For monitoring purposes, do you consider yourself to be disabled? Yes No

If you do have a disability which may affect your work, please give details in order that the appropriate support may be provided:                                                                                               

Are there any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the Job?                                   

How did you find out about this position?                                                  

I give consent for Personal Data divulged in applications and forms for employment to be kept on files (bothmanual and computer) for recruitment, monitoring and employment purposes. Information will be stored securelyin line with the Data Protection Act 1998.

                                                       Signed:       Date:      

Registered Address: 33 East Street, Havant, Hants, PO9 1AA. I & P Registration Number: 29937R

Declaration of Criminal Record – strictly private and confidential

Guinness Care and Support welcomes applications from ex-offenders as part of its equal opportunities policy and a criminal record would not necessarily be a bar to obtaining a position. However, it is important that we check whether you have been convicted of a criminal offence (other than a spent conviction under the Rehabilitation of Offenders Act 1974) which may affect your suitability for this post.

This information is not passed to those shortlisting, which is purely based on your ability to do the job. If you are shortlisted you may be contacted to discuss any relevant information on this form to ensure it is possible for you to be considered for the post. The interview panel may wish to discuss this further with you if you are offered an interview.

Please complete this form

Have you ever been convicted of a criminal offence or

given a formal reprimand, final warning or caution by the police?

If yes, please provide details

Date of Offence Nature of Offence Sentence or nature of Police Sanction

                             

                             

                             

   

                              

                              

                         

                                      

                                      

                        

NB: Failure to declare a current conviction may disqualify you from employment or result in summary dismissal when the dishonesty comes to light.

Is there any other non-conviction information (eg. pending prosecution) which may have a bearing on your suitability for this post?                                                                                                                                                      

I give consent for Personal Data divulged in applications and forms for employment to be kept on files (both manual and computer) for recruitment, monitoring and employment purposes. Information will be stored securely in line with the Data Protection Act 1998.

                    Signed:       Date:      

Working with children or vulnerable adults

Please note that anyone offered a post that requires working with children or vulnerable adults will be asked to apply for a Disclosure from the Criminal Records Bureau, in addition to any information provided above. Any offer will be conditional on a satisfactory Disclosure and you would receive a copy of this.

Further information about the Disclosure Scheme can be found on www.disclosure.gov.uk. A copy of Guinness Care and Support’s policy on employing people with a criminal record is available on request.

Registered Address: 33 East Street, Havant, Hants, PO9 1AA. I & P Registration Number: 29937R

Yes No