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Application for employmentPlease complete all sections – refer to our Guide to applying for jobs before completing. Press F11 on your keyboard to tab between fields.

Post applied for:      

Vacancy reference: BH     

Existing Bolton at Home employee? Yes: No:

Personal details

Title (Mr/Mrs/Ms/Other):       Full name:      

Address:                

Post code:      

Mobile N°:      Work N°:      Email:      We will contact you via email if your application is successful.

National Insurance N°:      

All posts within Bolton at Home are open to job share unless otherwise stated.Do you wish to job share (if applicable)?Yes: No:

DeclarationI declare that to the best of my knowledge and belief, all statements contained in this form are correct and I understand that should I conceal any material fact, I will, if engaged, be liable to the termination of my contract of service, with such notice as appropriate.

Signed:       Date:      

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Returning your completed applicationWhen completed, your application should be returned by:

email to hello@boltonathome.org.uk post/hand deliver to:

Workforce DevelopmentBolton at Home98 Waters Meeting RoadThe ValleyBolton BL1 8SWPlease email your completed application form where possible. If your application is successful, we will inform you by email.If you are returning your application by post, please ensure you add the correct postage payment. Failure to pay the correct postage will delay the receipt of your application. We cannot be responsible for applications received after the closing date due to incorrect postage payments or the postal services failure to deliver your application on time.

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Fairness in employment monitoring – strictly confidentialThe information you give us on this form will be used for monitoring only and will not be used for any other purpose. The form will be separated from your application on receipt.

Post applied for:      

Vacancy reference: BH     

Where did you see vacancy advertised?

Staff intranet: Jobcentre:

UCAN centre: Word of mouth/friend:

Bolton at Home website: Jobs board:

Other (please state):      

Do you currently reside in a Bolton at Home property? Yes No

What is your ethnic origin?

Asian / Asian British:

Bangladeshi: Indian: Pakistani:

Other Asian background:

Black / black British:

African: Caribbean: Other black background:

Chinese: Chinese:

Mixed: White/Asian: White/Black African: White/Indian:

White/Black Caribbean:

Other mixed background:

White: British: Irish: Other white:

Other (please state, e.g. Traveller):      

What is your gender?

Male: Female:

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What is your age group?

16-19 20-29 30-39 40-49 50-59 60-69 70+

What is your disability status?

No disability: Visual impairment:

Hearing impairment: Mobility difficulties:

Mental health disability: Learning disabilities:

Communication difficulties:

Other (e.g. epilepsy):      

What is your religion / belief?

Buddhist: Christian:

Hindu: Jewish:

Muslim: Sikh:

Atheist: Agnostic:

Other (please state):      

What are your caring responsibilities?

I look after children: I help an adult with his/her daily routine:

Both of the above: I have no caring responsibilities:

What is your sexual orientation?

Heterosexual / Straight: Gay / Lesbian:

Bisexual: Other (please state):      

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EducationGive details of any education – received in this country or abroad – and qualifications gained, listing the most recent first.

Where attended: Course title: Qualification & grade gained:

                 

                 

                 

                 

                 

                 

                 

                 

Job related qualifications & specialised trainingGive details of any job related and/or specialised training – received in this country or abroad – and qualifications gained, listing the most recent first.

Where attended: Course title: Qualification & grade gained:

                 

                 

                 

                 

                 

                 

                 

6Employment historyCurrent or most recent employment

Employer: Position held: From: To:

                       

Current salary:      Reason for leaving:      Length of notice required:      

Five years relevant employment history (Listing the most recent first)

Employer: Position held: From: To:

                       

Reason for leaving:      

                       

Reason for leaving:      

                       

Reason for leaving:      

                       

Reason for leaving:      

                       

Reason for leaving:      

Have you ever been dismissed by any of the above employers? (If YES, further details may be required from you.)Yes: No:

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References

Referee 1:

Full name:      Occupation:      Telephone:      Email:      

Address:                

Post code:      

Please indicate if your referee can be contacted prior to interview?Yes: No:

Referee 2:

Full name:      Occupation:      Telephone:      Email:      

Address:                

Post code:      

Please indicate if your referee can be contacted prior to interview?Yes: No:

Availability

Please indicate any dates during the next 8 weeks when you will be unavailable:     

Relationships

Are you related to any member of the board or any senior manager within Bolton at Home?

Yes: No:If YES, please give details:      

Driving license

Do you possess a current, valid driving license?

Yes: No:

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Data Protection Act 1988By completing this form and otherwise supplying information to Bolton at Home you agree that Bolton at Home may obtain, retain and process personal data supplied by you or relating to you for recruitment, vetting, selection and appointment purposes. And subsequently if you are employed by Bolton at Home for payroll purposes, training records, management of sickness absence, and as required or permitted by statute or regulation and generally as necessary under the employment relationship and Bolton at Home’s legitimate activities.

Equality Act 2010This act protects people with disabilities from unlawful discrimination. Bolton at Home uses the “two ticks” symbol, which means we are committed to employing people with disabilities. Candidates who have a disability and can demonstrate that they fulfil the minimum criteria for the post are guaranteed an interview.

Please indicate if you have a disability to enable us to deal with your application under the “two ticks” scheme. Yes: No:If YES, please state the nature of the disability:      

Do we need to make any special arrangements in order for you to attend the interview?Yes: No:If YES, please give details:      

Rehabilitation of Offenders Act 1974Under the rehabilitation of Offenders Act 1974 you are required to give details of convictions which are legally spent. A conviction will not necessarily be a bar to obtaining employment BUT failure to disclose any criminal conviction will disqualify you from this appointment and may render you liable to dismissal without notice.

Do you have a criminal conviction which is not legally spent?Yes: No:

If the post you are applying for is subject to a check under the Disclosure and Barring Service, you must disclose all criminal convictions, whether spent or not. You should read the guidance notes in the Guide to applying for jobs before you answer the following question.

Have you ever been convicted, cautioned or bound over in connection with a criminal offence?Yes: No:

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Relevant skills, knowledge and experienceThis is the most important part of your application. Please refer to our Guide to applying for jobs before completing.You must refer to the job profile when completing the competency section of your application. Please follow the instructions on the profile carefully and give examples using each competency as a heading. You are not required to give examples against the organisational competencies. You should show how and what you have done to meet the criteria. Provide examples of how you have carried out tasks or achieved results which demonstrate evidence of your ability to succeed in the new job. Be specific and detail your own responsibilities and not those of others.Attach any additional sheets to your application form and include your name and the post you are applying for as a ‘footer’ or title on each of the additional sheets. Please do not attach a CV.