Ronald Mcdonald House Charities Application Form: Section 1 Personal Details

Post Applied for :
Ronald McDonald House Charities Application Form

THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE
Section 1
Last Name: Address:
Personal Details
First Name:
Letters
Numbers
Letter
Postcode: Home Telephone: Mobile Phone: Email Address:
National Insurance No:
Are you free to remain and take up employment in the UK with no current immigration restrictions? Next of Kin Contact Details Last Name: Nature of Relationship: Work Telephone: Home Telephone: Mobile Phone: First Name:
YES
NO
If you are successful you will be required to provide relevant evidence of the above details prior to your appointment.
Page 1 of 7
Section 2
Present Employment
Present Employment (If now unemployed give details of last employer) Name of Employer: Address:
Postcode: Post Title: Date of Appointment: Department / Section: Brief Description of Duties: Salary:
Period of Notice: Reason of Leaving (if no longer employed):
Last Day of Service (if no longer employed):
Page 2 of 7
Section 3
Name of Employer: Address:
Previous Employment
Postcode: Position Held: Summary of Duties:
Reason for Leaving:
Section 4
Training and Development
Please give details of any training and development courses or non-qualifications courses which support your application. Include any on the job training as well as formal courses. Title of Training Programme or Course Duration of Course
Continue of a separate sheet if necessary

Page 3 of 7
Section 5
Personal Statement
Abilities, skills, knowledge and experience. Please use this section to explain how you meet the requirements of the role you applied for. If you are or have been involved in voluntary/unpaid activities, please also include this information.
Section 6
Rehabilitation of Offenders Act (1974)
Because of the nature of the work for which you are applying, the post is exempt from the provision of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offender Act 1974 (Exemptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are spent under the provision of the Act. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information will be completely confidential. Have you had any cautions, criminal conviction(s) or criminal conviction(s) pending, warnings or reprimands? Yes No If yes, please state their nature and date of conviction(s).
Page 4 of 7
Section 7
Protecting Children and Vulnerable Adults
The following information may be required if the post you are applying for has a requirement for a Criminal Records Bureau police check. Enhanced Checks Only Are you aware of any police enquiries undertaken following YES allegations made against you, which may have a bearing on you suitability of this post? NO
Section 8
Disability Discrimination Act
This Act defines a disabled person as someone who has a physical or mental impairment which has a substantial or adverse long term effect on his or her ability to carry out normal day-to-day activities. Using this definition, would you consider yourself to be disabled? If yes, please give details: YES NO
We will try to provide access, equipment or other practical support to ensure that people with disabilities can compete on equal terms with non-disabled people. Do we need to make any specific arrangements in order for you to YES attend the interview? If yes, please give details: NO
Page 5 of 7
Section 9
Recruitment Monitoring Form
This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by the House Manager purely for monitoring purposes. Application for the post of: What is your Ethnic Group? Asian or Asian British Bangladesh Asian or Asian British Indian Asian or Asian British Pakistani Asian or Asian British any other Asian background Black or Black British African Black or Black British Caribbean Black or Black British any other Black background Chinese Mixed White and Asian Mixed White and Black African Mixed White and Black Caribbean White British White Irish White any other White background Other Candidate preferred not to answer
Section 10
Gender Age Group
Recruitment Monitoring Form Continued

Male 16 25 46 55 Over 70 Female 26 35 56 65 36 45 66 70
Page 6 of 7
Section 11
Declaration
I hereby certify that: All the information given by me on this form is correct to the best of my knowledge All questions relating to me have been accurately and fully answered I possess all the qualifications which I claim to hold I have read and, if appointed, am prepared to accept the conditions set out in the conditions of employment and the job description. Signed: Date:
Ronald McDonald House Charity undertakes that it will treat any personal information (that is data from which you can be identified, such as your name, address, e-mail addresses etc) that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. If you are returning this form by email, you will be asked to sign you application at interview.
RETURNING THIS FORM

By Hand or Post: By E-Mail: Enquiries:
Page 7 of 7

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Post Applied for :

Ronald McDonald House Charities Application Form

Postcode: Home Telephone: Mobile Phone: Email Address:

National Insurance No:

Period of Notice: Reason of Leaving (if no longer employed):

Last Day of Service (if no longer employed):

Postcode: Position Held: Summary of Duties:

Reason for Leaving:

Training and Development

Continue of a separate sheet if necessary

Rehabilitation of Offenders Act (1974)

Protecting Children and Vulnerable Adults

Disability Discrimination Act

Recruitment Monitoring Form

Recruitment Monitoring Form Continued

RETURNING THIS FORM

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