Waterloo Housing Association - Job Application Form.

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APPLICATION FORM

Photo shows Nicola Hall, a work experience placement To apply for a position, please complete the application form below, then click on the Submit button at the end of the form.

If you run out of room on any of the fields below, please use the box at the end of the form, labeled 'Other Information'.

HELP

Guidance Notes for filling in this application form can be found here.

* - Answer Required

Which position are you applying for?*

Where you saw the vacancy*:
Details:

Personal Details

Title*	Mr Mrs Miss Ms
Surname*
Forename(s)*
Home Address*
Home Phone
Work Phone
Mobile Phone
Email* A copy of your completed application will be sent to your email address
Date of Birth (dd/mm/yyyy)*
Do you hold a full clean driving licence?	Yes No
Please give details if you have any current points
Do you have access to a car for work?	Yes No
Do you have the right to live and work in the UK?	Yes No
National Insurance Number

Waterloo Housing Association will not discriminate against ex-offenders with unreleated criminal records.

For posts that are exempt from the Rehabilitation of Offenders Act (1974), spent and unspent convictions must be disclosed in the space below. For all other posts, only unspent convictions must be disclosed. If this post is exepmt, this will be indicated on the Job Description. For some posts, we may seek information from the Criminal Records Bureau.

Have you ever been convicted of a criminal offence?	Yes No
If you answered yes, please give details of any unspent convictions below.

For exempt posts ONLY, please give details of spent convictions below.

Education

Schools Education Name of School	Dates	Qualifications	Grade

Further/ Higher Education (If shortlisted you will need to provide written proof of these qualification at interview) Name of Institution	Dates	Qualifications	Results

Training

Date Attended	Course Name

Membership of Professional Bodies

Professional Institute	Date	Qualification

Voluntary Work Undertaken

Organisation	Date	Work Content

Present or Most Recent Employer

Employer's Name & Address
Your Position
Date Appointed
If necessary, date terminated
Salary & Benefits
Period of Notice
Brief Description of Duties and Responsibilities
Reason for Leaving or Seeking Alternative Employment

Employment History

Name & Address of Employer	Position	Dates	Reason for Leaving

Reason for Applying*
Please state why you are interested in this position, supported by details of any particular knowledge, skills and experience you may have. Please show why you would be suitable by taking into account any information you have been sent relating to the job.

References
Please provide the names and addresses of two referees (one of which must be your current/ most recent employer). They must not be related to you.

Reference 1	Reference 2
Name*	Name

Address*	Address

Email	Email

Daytime Telephone (in. STD)	Daytime Telephone (inc. STD)

Their position and relationship to you	Their position and relationship to you

Reference Type	Reference Type

May we contact these references prior to interview?
Reference1	Reference 2

Declaration of Interest
(This section is to ensure compliance with Schedule 1 of the Housing Act 1996)

Do you have a close relative who is already an employee of Waterloo?	Yes No
Do you have a close relative who is already a Board Member with the Waterloo Group?	Yes No
Do you have a close relative who is or has been in the last 12 months a supplier of goods/ services to the Waterloo Group?	Yes No
Do you have a close relative who is or has been in the last 12 months a tenant/ leaseholder of the Waterloo Group?	Yes No
If you have answered yes, please give details

DIVERSITY MONITORING

Waterloo Housing Association is opposed to discrimination on any grounds. In particular, we oppose discrimination on the grounds of race, religion, ethnic origin, sex, sexuality, marital status, disability and age. We are committed to ensuring that ability and potential for the job are the only criteria used for selection and that through our policies we can achieve a balanced workforce.

Waterloo Housing Association adheres to the Code of Practice published by the Commission for Racial Equality and the Code of Practice published by the Equal Opportunities Commission, regularly monitoring the effects of selection decisions to assess if diversity is being achieved.

To this end you are requested to complete the form below. This information will not be used for short-listing purposes.

General

Gender	Male: Female:
Age

Ethnic Origin
This refers to a 'racial group' defined by the Race Relations Act 1976 as "a group of persons defined by reference to colour, race, nationality, or ethnic or natural origins". Please describe your ethnic origin by ticking the appropriate box.

White	Black or Black British
British	Caribbean
Irish	African
Other *	Other *
Mixed	Chinese or other ethnic group
White and Black Caribbean	Chinese
White and Black African	Other *
White and Black Asian
Other *
Asian or Asian British
Indian
Pakistani
Bangladeshi
Other *
If you selected Other* please give details:

Health & Disability

If you have had any sickness absence from work in the past 24 months, please give the number of days and reasons

Were any of these absences related to a disability?

Do you consider yourself to have a disability?	Yes No
If yes, are there any adjustments or arrangements we can make to assist you in the selection process?

Continued...

Please use this field if you have run out of room on any of the fields on this form

I declare that the information set out in this application form is, to the best of my knowledge true and complete. I understand that any false information may disqualify my application, or if employed, may lead to my dismissal.

If the above statement is true, click on the Submit button below to send your details to Waterloo.

Thank you