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Job Application

    Personal Information (Confidential)

    Job you are applying for:

    Department or team:
    (if known)

    Personal Details

    Title:

    First Name:

    Last / Family Name:

    Address:

    Post Code:

    Telephone number:

    E-mail address:

    National Insurance Number:

    Please tell us what attracts you to this job and how it matches your skills and experience:


    Please note: If you exceed the space provided, please complete on a separate sheet of paper.

    Tell us about your work history (including self-employment and volunteering)

    Start Date

    End Date

    Employer’s name & address

    Job role & key responsibilities

    Reason for leaving

    Your formal education and training (please start with your highest academic qualifications first)

    Start Date

    End Date

    School / College / University

    Course(s)

    Qualification / grade

    Tell us about any other training you have had

    Start Date

    End Date

    Details of the training

    Qualification (if applicable)

    First/native language

    Other languages spoken

    Name

    Level

    Please name two people who can act as Referees

    They should not be relatives. Employment subject to satisfactory references. Your current employer will not be approached without your permission.

    References 1

    Name:

    Job Title:

    Organisation:

    Relationship to you?

    Email Address:

    Telephone Number:

    References 2

    Name:

    Job Title:

    Organisation:

    Relationship to you?

    Email Address:

    Telephone Number:

    Do you consider yourself to have a disability?
    (According to the definition in the Equality Act 2010?)

    If you have a disability, please tell us about any adjustments we need to make to assist you at interview

    If you require any reasonable adjustments to the recruitment process, including the application process and interview, please provide details on a separate sheet of paper


    Are you free to remain and take up employment in the UK?

    Please note that you will be required to provide appropriate documentary evidence of this at interview. For examples of acceptable documents please see www.ukba.homeoffice.gov.uk


    Are you related to any current Apasen employee / volunteer or trustees?


    If yes, please confirm their name and the relationship you share?


    Have you ever been convicted of a criminal offence which is not a spent conviction?

    (Within the terms of the Rehabilitation of Offenders Act 1974)


    If yes, please give full details

    Apasen undertakes not to discriminate unfairly against any applicant based on a conviction or other information revealed


    How did you hear about this job?

    EQUAL OPPORTUNITY MONITORING FORM

    Please complete and return it with your application form.

    Apasen is committed to promoting fairness and eliminating discrimination from recruitment and selection practices. We will ensure that no job applicant or employee received less favourable treatment either directly or indirectly, on the grounds of age, race, disability, gender, marital status, religion or faith or sexual orientation.

    This is sensitive personal data and will be treated with the utmost confidentiality in line with the requirements of UK General Data Protection Regulation (UK GDPR) legislation. The data will not be considered in assessing information on your application form.

    To monitor and audit the effective delivery of this commitment, Apasen requires all applicants to provide information asked for in this monitoring form. This will only be used for this purpose; it will not be part of the interview process and will be treated in strict confidence.


    Job title:

    Gender


    Is the gender you identify with the same as your gender registered at birth?


    Age

    What is your Ethnicity?

    Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box


    Asian or Asian British

    Black, African, Caribbean, or Black British


    Mixed or Multiple ethnic groups


    White


    Other ethnic group

    Prefer not to sayPrefer not to say


    What is your sexual orientation?


    Gender re-assignment
    Have you gone through any part of a process (including thoughts or actions) to change from the sex you were described as at birth to the gender you identify with, or do you intend to? (This could include changing your name, wearing different clothes taking hormones or having any gender reassignment surgery).


    What is your religion or belief?


    Disability

    The Disability Discrimination Act 1995 (DDA) defines a person as disabled if they have a physical or mental impairment which has a substantial and long term (i.e., has lasted or is expected to last at least 12 months) adverse effect on one’s ability to carry out normal day-to-day activities. This definition includes conditions such as cancer, HIV, mental illness and learning disabilities.


    Do you consider yourself to have a disability according to the above definition?

    The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’, then please discuss this with your manager, or the manager running the recruitment process if you are a job applicant.


    If you selected yes, please indicate your disability:

    Carer responsibility


    Do you look after, or give any help or support to family members, friends, neighbours, or others because of either:

    • Long-term physical or mental ill-health / disability

    • Problems related to old age.


    If you selected yes, please indicate your caring responsibility (select all that apply):