Applying for Activity Co-ordinator position

Title:
Mr Mrs Ms Miss Dr
Date of birth (if under 18 - dd/mm/yyyy):

Address


Reference 1
Name:

Job title:

Address

Relationship to applicant:

Telephone:

Do not contact before interview: 


Current/Most recent employer

Name:

Address

Date from:

Brief explanation of duties:

Forename(s):

Surname:


Telephone number (Home):

Telephone number (Work):





Reference 2
Name:

Job title:

Address

Relationship to applicant:

Telephone:

Do not contact before interview: 



Telephone:

Nature of business:

Position held:

Salary:

Date to:

Reason for leaving:

Previous employers
please give company names, positions, dates and reason for leaving previous employers


Training/Qualifications
Please give qualifications, grades and dates passed


Relatives
Are you related to anyone working for this organisation? if so please give details including name and place of work:


Rehabilitation of offenders act 1974
Because of the nature of the work for which you are applying, this position is exempt from the provisions of section 4 (2) of the rehabilitation of offenders act 1974. You are therefore not entitled to withhold information about convictions which for other purposes are "spent"under the provisions of the act. Any information given will be completely confidential and will not automatically prevent you from being considered for this position.
Have you ever been convicted of a criminal offence? Yes: No:
if so please provide details including date and place of conviction:


Disability
In order to enable us to help annyone who has a disability to proceed their application and to subsequently fulfil the duties of the position, we need to know of any reasonable adjustments which may be necessary to help him/her attend an interview or undertake the duties of the position.
If you have (or think you may have) a disability, please give details below:
This information will not be used to discriminate against disabled applicants


Working Eligibility
Are you eligible to work in the UK?
Yes: No:

Do you have a valid work permit (if applicable)?
Yes: No:

Drivers License
Do you have a full, valid UK drivers license?
Yes: No:

Declaration
By ticking the box below I authorise Oakbridge Retirement Villages to obtain references to support my application and confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed dismissal. I also authorise Oakbridge Retirement Villages to keep and use the information on this form and any subsequent information relating to my application and/or employment, in accordance with the Data Protection Act 1998. I understand that any offer of employment will be subject to a satisfactory disclosure and POVA check from the Criminal Records Bureau(CRB), 2 satisfactory references, medical clearance and evidence of the right to work in this country.

I agree: