On-Line Application Form

There a several ways to obtain an application pack.

1. You can print or download an application pack via Job (Please Click for a downloadable version) APPLICATIONFORM_PDF.pdf

2. Contact your Regional Office via telephone for a form to be sent out to your home address

3. Apply for a pack via email

4. Complete the on-line application form.

To complete an on-line application form please fill in the following, in as much detail as possible.

Thanks

Please refer to the guidance notes for completing an application form. CV's will not be accepted on their own unless you are unable to complete the application form because of your disability.

Your Details

Please fill out the info as detailed as you can

Position Applied For *

Location *

Forenames *

Surname *

Home Telephone Number: *

Mobile Number:

Address *

Line 1
Line 2
Town
County
Postcode
Country

email address *

REFERENCES: Please give details of two referees including your current or most recent employer. (FRIENDS AND RELATIVES ARE NOT ACCEPTABLE)

Name of 1st Referee *

Address of 1st Referee *

Line 1
Line 2
Town
County
Postcode
Country

Contact Name of 1st referee *

Job Title

In what capacity is this person known to you? *

Contact Number for referee: *

Please give details of your 2nd referee:

Name of 2nd Referee:

Address of 2nd Referee:

Line 1
Line 2
Town
County
Postcode
Country

Contact Name:

Job Title

In what capacity is this person known to you:

Contact Number:

Are you related to any employees or committee members of Perthyn? If yes, please state who and the relationship: *

Have you ever been cautioned or convicted of a criminal offence, including whilst a juvenile/youth? if yes, please give details with date and result: *

I certify that the particulars given above are correct and I authorise Perthyn to apply to the Criminal Records Bureau on my behalf to release information held in respect of any cautions or convictions I hold. I understand that incorrect or incomplete details or failure to disclose any cautions or convictions may exclude my application from further consideration and/or provide grounds for dismissal.

EMPLOYMENT HISTORY: Please list below details of your FULL employment history since leaving school, starting with your present or most recent employer. Please ensure dates employed are provided in month/year format. This is a requirement of Perthyn's regulatory bodies.

Current or most recent employers Name: *

Dates employed (MM/YYYY) *

Job Title *

Summary of Duties *

Salary *

Reason for Leaving *

Details of 2nd employer. If applicable:

Employers Name:

Dates Employed (MM/YYYY):

Job Title:

Summary of Duties:

Salary:

Reason for Leaving:

Details of previous employer. If applicable:

Employers Name:

Dates Employed: (MM/YYYY)

Job Title:

Summary of Duties:

Salary:

Reason for Leaving:

Details of any other employer:

Employers Name:

Dates Employed: (MM/YYYY)

Job Title:

Summary of Duties:

Salary:

Reason for Leaving:

Please give details of any periods of non-employment:

EDUCATION

Secondary Schools Attended: *

Dates Attended From and To: *

EXAMINATION ATTAINMENTS

FURTHER EDUCATION

College/University:

College/University

Dates attended To and From:

Dates Attended To/From:

Qualifications Obtained:

TRAINING (in relation to the post for which you are applying)

College/Provider

Date obtained:

Qualification(s) attained/Subject of course:

SUPPORTING INFORMATION This section of the application form is intended to give you the opportunity to let us know how your experience, skills and views meet the criteria for the post. Please ensure that your responses relate as directly as possible to the person specification. Please use additional sheets if necessary.

What attracted you to apply for this vacancy? *

Please outline your views on issues faced by people with learning disabilities. *

Please outline what experience/knowledge you may have which is relevant to this position. *

Please outline any personal skills or interests you possess which may be useful for this position. *

Is there any additional information that you would like to give about yourselfin suuport of your application? (Please continue on a seperate sheet at the back of the application form)

TRANSPORT

Do you own a car? *

Do you have a driving licence? Full/Provisional/None? *

Are you prepared to use your car in association with work? *

Please give details of any endorsements: *

AVAILABILITY & IMMIGRATION CONTROL

Please state any time you would not be available to attend for interview:

What is your current notice period? *

In many of our schemes we provide support 24hrs a day for 365 days of the year and staff are therefore normally expected to work the full range of shifts. Would you find working any of the following a problem: Days, Nights, Weekends, Bank Holidays. *

Please state the type of working hours you are seeking: Full-time, Part-time, casual: *

No of hours you are prepared to work per week: *

Are you subject to immigration control? *

Have you ever had any other nationality or citizenship? *

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

DATA PROTECTION

Perthyn will use the information given by you only to assess your application and for statistical purposes, for example to analyse applications by gender, ethnic origin or disability. Perthyn retain information about job applicants for 6 months. Application forms for successful candidates are retained on their personal file

APPLICANT'S DECLARATION

For the purposes of the Data Protection Act, I consent to the information contained in this application form, and obtained pursuant to it, being processed by the organisation for the purposes of my application for employment with Perthyn. I also confirm that to the best of my knowledge all of the information given above is correct. The wilful provision of inaccurate or misleading information will lead to the termination of employment.

Name: *

Date: (dd/mm/yyyy) *