Job application form

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The information provided on this application form will remain private and confidential and will be used as part of the recruitment process for the purpose of selecting and recruiting applicants. We will hold and use any personal data (including special categories of personal data) relating to you in accordance with our legal obligations.

If you have any difficulty completing this form and would like to explore alternative application methods with us, or if you require any adjustments to the application and/or recruitment process, please contact Saira Chuttun on 0208 640 8413 or

patochiefexec@headway.org.uk.

For all other queries relating to the job, please email enquiries@headway.org.uk.

Position you wish to apply for

Personal details

Title

First name

Last name

Address 1

Address 2

City/town

Postcode

Telephone - mobile

Telephone - home

Employment history

Please provide details of your current or most recent employment:

Employer's name

Employer's business

Address

Job title

Brief description of duties

Salary

Start date

End date

Reason for leaving

Notice period

Employment history (continued)

Please provide details of your employment over the last 10 years (not including the employer detailed in section 2 above). For each role, please include the name of employer, position held, employment dates and a brief outline of your reason for leaving.

Education and training

Please provide details of your school (secondary) qualifications. For each, please include the name of the school, title of the course/examination, and the grade/level achieved.

Please provide details of your further education (college/university) qualifications. For each, please include the name of the institution, title of the course/examination, and the grade/level achieved.

Additional/professional qualifications/memberships obtained and dates.

Professional registration number/expiry date (if applicable)

Please provide details of any further management or professional courses attended, if relevant to the position.

Supporting information

Please give briefly any additional information you consider important to the position, including details of previous positions, relevant experience and why you think you should be considered for the position. Please ensure that this information clearly demonstrates how you meet each of the requirements of the person specification.

Personal statement

In no more than 150 words please tell us what qualities, skills and knowledge you would bring to this role.

References

Please give the details of two persons who should not be related to you and who have consented to act as a referee, one of which must be your current or last employer. If you have just completed full time education the Head/Principle and/or Tutor should be given. We will not approach your referees without your approval.

Referee 1

Name

Address

City/town

Postcode

Telephone

Relationship

Referee 2

Name

Address

City/town

Postcode

Telephone

Relationship

Declaration

Do you have the right to work in the UK?

YesNo

Do you have any relationship or connection to a person who is a current employee of Headway?

YesNo

If yes, please provide details

How did you hear about this role?

If other, please tell us where

I confirm that the information I have given on this form is accurate and complete to the best of my knowledge. I accept that any omission or misrepresentation of any facts within this application form is a ground for refusal of employment or should this application lead to employment, disciplinary proceedings (and, in appropriate cases, dismissal and/or criminal charges). I understand that should an offer of employment be made it will be subject to completing, to Headway’s satisfaction, certain pre-employment checks including confirmation of my right to work in the UK and details of any unspent convictions for a criminal offence. I accept that as part of the recruitment process, Headway may need to approach former employers, educational establishments and government agencies for verification of the information provided and provide authority for the company to do so.

Date

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