Unique Identification
Number:
Before completing this application form please refer to the Guidance Notes
Post applied for
Post Reference Number
Please ensure your full name and contact details are completed on the equality and diversity form
Current or most recent employment
Job Title Dates of employment
From:                             To:
Name and address of employer
Period of notice required Salary
Reason for leaving/wishing to leave
Brief description of duties and responsibilities
Previous positions
Please provide details of all jobs held in the past 10 years including unpaid work, starting with the most recent. The successful applicant is required to provide dates of employment for verification purposes.
Dates employed
From:      To:		 Name and address of employer Post held Salary Reason for change
       
You may continue on a separate A4 sheet
Qualifications
Please give information on your relevant qualifications, giving the earliest first, eg education qualifications, professional qualifications, technical qualifications.
Qualification Subject Result
Grades/Level		 Name of Educational Institution
College/University
     
Original certificates will be required to be produced as proof of qualifications as a pre-condition of employment.
By signing this application form, the successful applicant agrees to a verification check of qualifications by the Group if required.
Training
Please detail any training that you have received that is relevant to the post for which you are applying.
(In the past 10 years)
Course(s) Dates
 
Other information
Membership of professional bodies/voluntary work.
Do you hold a current driving licence? Yes No
Car owner? Yes No
To your knowledge are you related to a present Board or staff member? Yes No
If ‘Yes’ give details    
 
Have you applied for, or worked in any other position with the Group previously? Yes No
If ‘Yes’ give details    
 
Supporting Information: relevant skills, knowledge and experience
You can mention any experience gained through work, school, college, at home, voluntary work, work experience or through hobbies. Please refer to the Person Specification and Guidance Notes to ensure you address all points on the Specification.
You may continue on up to two additional A4 sheets of paper.
References
Please give the names of two people who could provide a reference about your suitability.
The first referee must, where applicable, be your present or last employer if unemployed.
If you are known to your referee by a previous surname please state name
1. Name
  Position
  Company Name
  Address
   
   
  Tel no                              Fax no
  Email
2. Name
  Position
  Company Name
  Address
   
   
  Tel no                              Fax no
  Email
May we take up references prior to an offer of employment being made?     Yes      No
Is this an employer reference (Please tick the
appropriate box)
or personal reference?
May we take up references prior to an offer of employment being made?     Yes      No
Is this an employer reference (Please tick the
appropriate box)
or personal reference?
Successful applicants will be responsible for producing proof of eligibility to work in the UK. As proof they will need to produce documents prior to taking up an appointment, eg Passport or Birth Certificate. Are there any restrictions to your residence in the UK which might affect your right to take up employment in the UK?
Yes      No
Do you have a criminal record? If so, please give details.
(This does not mean that your application will not be considered)		 Yes No
Declaration of Criminal Offences
In order to protect the interests of the community, every effort is made to ensure the information provided by applicants is accurate. This is achieved by the potential employee being asked to apply for a “Disclosure” from the Criminal Records Bureau for certain posts. The Rehabilitation of Offenders Act of 1974 states that an individual who has a conviction for a criminal offence is, after a specified time, allowed to treat the conviction as if it never occurred ie the conviction is “spent”. Only offences which are not “spent” need to be declared. The Rehabilitation of Offenders Act 1974 provides that certain conditions shall be regarded as spent at the date you sign the application form. Applicants are reminded that certain posts are exempt from the 1974 Act, and therefore you may be required to reveal any criminal convictions you might have, including any which may otherwise be considered “spent” under the Act. An Application Form Attachment will be included in the pack if the post is exempt.

The Data Protection Act 1998 states that by signing this form, it is assumed that the applicant agrees to the processing of sensitive personal data in accordance with the Group’s registration with the Data Protection Information Commissioner.
I declare that the information I have given in this application is accurate and true.
I understand that providing misleading or false information will disqualify me from appointment OR, if appointed, may result in my dismissal.
Signature
Date
Please return to
Personnel Section
Adactus Housing Group Ltd
Turner House
56 King Street
Leigh Lancashire WN7 4LJ
t: 01942 608715
f: 01942 261538

Registered office: Turner House, 56 King Street, Leigh, Lancashire WN7 4LJ