Youth Action Application Form

APPLICATION FOR EMPLOYMENT
Position Applied for?
Where did you hear about this vacancy?
Personal Details
Surname: *
Forename(s): *
Address: *
Postcode: *
Mobile Telephone Number:*
Home Telephone Number:
Work Telephone Number:
Email*

Confirmation Emailexample@example.com
Employment Record

Please list your employment record, present and past; beginning with the most recent
Name & address of employer:
Job Title:
Period of Employment:
Summary of your duties and responsibilities related to your present or most recent job:
Previous Employment
Please list your previous employers:
Name & address of employer
Period of Employment
Job title & main duties
Any relevant qualifications and courses
Supplementary Information
Health / Medical Information
Have you suffered or do you suffer from any recurring health problem(s) likely to affect your ability to perform in the post?*
Driving Information
Do you hold a current driving licence?

YESNO
Are you a car owner?

YESNO
If yes, would you be prepared to use your vehicle for work purposes?

YESNO
Further Details
Please explain why you feel you are the appropriate person to for this post, what experience and qualities you will bring to the organisation. (This is an important part of your application; please take time to complete it fully).
Referees
Please give details of 2 people who can provide a reference on your behalf. One must be your present or most recent employer. Your referees will not be contacted until an offer of employment has been made.
Name & Address (1)*
Position
Email
example@example.com
Name & Address (2)*
Position
Email
example@example.com
Declaration
I verify that, to the best of my knowledge, the information supplied by me on this application form, and on any additional sheets submitted, is correct.
Signature*
Do you agree to an auto-response email?*

yes
Please verify that you are human*
.
Office Use
Reference:
Closing Date:
Closing Date:

MonthDayYear
Date
Received:
Equal Opportunities Monitoring Form
In order to monitor the effectiveness of our Equal Opportunities Policy, which the Project operates in line with West Lothian Council guidelines, all applicants are asked to complete this form and return it with your application.
Please choose from the drop dowm.
Section 1
Gender
Section 2
Are you regarded as disabled under the Disability Discrimination Act 1995?

YESNO
Section 3
These ethnic monitoring categories are recommended by the Commission for Racial Equality for inclusion in the 2001 census. Please choose the category that you feel most closely associates with your ethnic or cultural background.
White
OTHER, please specify
Black
OTHER, please specify
Asian
OTHER, please specify
Chinese
OTHER, please specify
Other Asian (e.g. Japanese, Vietnamese)
Mixed Race, please specify
Other, please specify
Should be Empty:

APPLICATION FOR EMPLOYMENT

Personal Details

Employment Record

Previous Employment

Supplementary Information

Health / Medical Information

Driving Information

Further Details

Referees

Declaration

Office Use

Equal Opportunities Monitoring Form

Section 1

Section 2

Section 3