APPLICATION FORM



|The following information will be treated in the strictest confidence |

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|PERSONAL DETAILS |

|Surname: | |First Name(s): | |

|Address: | |

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|Tel. No: |Work Tel No. |

|Email address: |Mobile No. |

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|Do you own a vehicle YES/NO Do you have a current driving licence? YES/NO |

|*Have you any current endorsements YES/NO |If yes, please give further details including dates: |

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|Have you any convictions, including both spent and unspent convictions under the Rehabilitation of Offenders Act 1974? (A copy |YES/NO |

|of the Prince’s Foundation Disclosure and Protection of Vulnerable Groups Policy is available on request.) | |

|If YES, please give full details | |

|Do you hold a PVG or a D&B check? |If YES, please give reference number: |

|Do you hold any public duties (e.g. J.P. local government) |YES/NO |

|If YES, please give full details | |

|Are you in good health? |YES/NO |

|If NO, please give full details | |

|Do you have any disabilities which may affect your employment |YES/NO |

|If YES, please give full details. | |

|Please give details of any adjustments that may be required to assist you in your job application: |

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|Please also give details of any reasonable adjustments which may be required to the job itself which would enable you to carry out the job, should you be offered |

|employment. |

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|Are there any restrictions to your residence in the UK which may affect your right to take up employment in the UK? |YES/NO |

|If offered employment, would you require a work permit prior to taking up employment? |YES/NO |

EMPLOYMENT DETAILS

Please give details of your present and past employment, starting with your present or most recent employer:

|Name and Address of Employer |Dates |Job Title, Duties & Responsibilities |Reason for Leaving |

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|Name and Address of Employer |Dates |Job Title, Duties & Responsibilities |Reason for Leaving |

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|Name and Address of Employer |Dates |Job Title, Duties & Responsibilities |Reason for Leaving |

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EDUCATION

|QUALIFICATIONS (include Occupation |From |To |Courses and Results / Qualification |

|Qualifications) | | | |

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|Other Relevant Training Courses |Subject and Dates |

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|INTERESTS, ACHIEVEMENTS |

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|Please give details of hobbies, sports, offices held in clubs, community work, etc |

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|ADDITIONAL INFORMATION |

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|Please give any additional information in support of your application |

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|DECLARATION |

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|I confirm that the information provided on this form is true and accurate. I understand that false information or deliberate omissions may disqualify me from |

|appointment, or if employed, may result in my summary dismissal. |

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|I understand that these details will be held in confidence for the purposes of assessing this application. If employed, I understand the information will be used in |

|the administration of my employment in accordance with the Data Protection legislation. |

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|Signature: |

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|Date: |

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|REFERENCES |

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|Please provide the names of two people who may be contacted for a reference (one must be your current or most recent employer). |

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|Are you happy for us to contact your current employer before an offer of employment is made? YES/NO |

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|Name: |

|Name: |

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|Position: |

|Position: |

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|Address: |

|Address: |

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|Tel. No: |

|Tel. No: |

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|Email address: |

|Email address: |

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