|
* POSITION APPLIED FOR:
|
|
* Surname:
|
* Forename(s):
|
* Title:
|
|
* Address:
* Postcode:
|
|
* Date of Birth:
|
* Telephone Number:
|
|
* Email Address:
|
|
* NI Number:
|
|
|
Details of endorsements:
|
|
|
| EDUCATION HISTORY |
| Schools (type only, eg. technical, grammar etc.) |
Qualifications Gained |
|
|
|
|
|
|
| Colleges/Universities |
Qualifications Gained |
|
|
|
|
|
|
|
Other training
|
| OTHER EMPLOYMENT |
|
Please note any other employment you would continue if you were to be successful in obtaining this position:
|
| EMPLOYMENT HISTORY (Please complete in full) |
| From - To |
Name and Address of Employer |
Job Title and Duties |
Start/Finish Salary |
Reason for Leaving |
|
|
|
|
|
|
|
|
|
|
Notice required in current post:
|
| REFERENCES |
|
Please note here the names and addresses of two persons from whom the company may obtain both character and work experience references
|
|
|
|
|
| LEISURE |
|
Please note here your leisure interests, sports and hobbies, other pastimes etc.
|
| CRIMINAL RECORD |
|
Please note any criminal convictions except those 'spent' under the Rehabilitation of Offenders (Northern Ireland) Order 1978. If none please state. In certain circumstances employment is dependent upon obtaining a satisfactory disclosure of criminal records.
|
| GENERAL COMMENTS |
|
Please detail here your specific reasons for this application, your main achievements to date and the strengths you would bring to this post.
|
| HEALTH DETAILS |
|
Do you have any physical or mental impairment which has a substantial and long term effect on your ability to carry out day to day activities?
Yes
No
|
|
Please specify any special arrangements for work associated with any impairment.
|
|
Please specify any special arrangements you will need to attend an interview.
|
|
Please list any diseases, disorders, allergies, muscular or musculoskeletal injuries from which you have suffered or do suffer.
|
|
Please detail any form of medicine, drugs or treatment you are currently and/or regularly receiving.
|
|
Please list all absences from work in the past 12 months and the reasons for such absences.
|
| DECLARATION (Please read this carefully before submitting this application) |
-
I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate and employment contract offered.
-
I agree that the organisation reserves the right to require me to undergo a medical examination. (Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor). I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
-
I agree that should I be successful in this application, I will, if required, apply for a disclosure of criminal records. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment temrinated.
* Signed:
* Date:
|
| FAIR EMPLOYMENT - QUESTIONNAIRE |
|
Date:
|
Position Applied For:
|
EQUALITY OF OPPORTUNITY
We are an equal opportunity employer. We do not discriminate on grounds of religious belief or political opinion. We practice equality of opportunity in employment and select the best person for the job.
To demonstrate our commitment to equality of opportunity in employment we need to monitor the community background of our employees, as required by the Fair Employment (Northern Ireland) Act 1999.
Regardless of whether we practice our religion, most of us in Northern Ireland are seen as either Roman Catholic or Protestant. We are therefore asking you to indicate your comunity background by selecting the appropriate option below.
I am a member of the Protestant community
I am a member of the Roman Catholic community
I am a member of neither the Protestant nor Roman Catholic community
Could you please indicate whether you are:
Female
Male
If you do not complete this questionnaire, we are encouraged to use the 'residuary' method which means that we can make a determination on the basis of personal information on file.
Note. It is not compulsory for you to answer the above questions. However we would stress that it is a criminal offence under the legislation for a person to "give false information in connection ... with the preparation of a monitoring return".
|
