Application form for employment
Post Information
Post applied for:		Ref:
Location:		Where advertised?:
Have you applied for a post with Abbeyfield before?YesNo
Have you been employed by Abbeyfield before?YesNo
If Yes, please give details?

Personal Details
Title	MrMrsMissMsDr
Surname
Firstname
Home address		Email  address
Postcode		Mobile number
Home telephone		Daytime number (if convenient)
Do you possess a current, clean driving licence?		YesNo
Please give details of any penalty points and reason.

Employment History
Current/most recent employer's name & address	Position held and main duties	Start	Finish	Reason for leaving
Salary		Notice period

Please provide details of all other employment, in sequence with the most recent first.
Previous employer's name & address:	Position held	Start	Finish	Reason for leaving

Education \ Training

Please give details of your education (schools, colleges, higher education) and qualifications obtained. Please give details of any professional, specialist or job related courses attended (with dates), certificates obtained and any membership of professional bodies.

Establishment Subjects Start Finish Result/Grade

Statement in support of your application

Please tell us why you are a suitable candidate for this role, highlighting your key achievements and any other relevant information that supports your application.

References
Please provide us with details of 3 referees below.  If you do not wish any reference to be sought until you give permission, please enter a tick in the relevant box.
Present / Last Employer
Name	Address	Occupation	Tel no.
Previous Employer
Name	Address	Occupation	Tel no.
Personal reference
Name	Address	Occupation	Tel no.

Convictions Please enter below details of conviction for any offences or formal cautions by police for any offence or any bind-overs imposed by any court.  You must include spent convictions under the Rehabilitation of Offenders Act 1974 Have you ever had any cautions/convictions?  YesNo Date of offence/offences. Give details. Result Abbeyfield carries out Criminal Records Bureau (CRB) checks on all successful candidates.

Declaration
I hereby declare that I have answered all questions fully and truthfully and understand that a false or misleading information will lead to my disqualification.  Under the Data Protection Act 1998 I understand that personal information about me may be held on or verified by computer for personnel/employee administration purposes including analysis for management purposes and statutory returns.
Please type yes in the box provided if you agree to the above declaration	Date

Equality & Diversity Statement

Abbeyfield is committed to an Equality & diversity Policy and will ensure that no individual or group is treated less favourably in employment on the grounds of gender, race, disability, sexual orientation, religion or belief, age or Nationality. Please fill in this form as fully as possible so that we can monitor the implementation of our Equal Opportunities Policy. The answers you provide in this section will be treated in the strictest confidence and will only be used for statistical monitoring.  This section will be detached from the application form before the shortlisting and interview process begins.

Please tick the appropriate boxes

I amMaleFemale

Marital StatusMarried / Civil Partnership Other

I would describe my ethnic origin as: White British Irish Any other white background Mixed White and Black Caribbean White and Black African White and Black Asian Any other mixed background Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background Black or British Black Caribbean African Any other black background Chinese Chinese Other ethnic group Any other ethnic group Please state

Religious belief (Optional)ChristianBuddhistHinduJewish MuslimSikhOtherNo Religion