Application Form - Personal Assistant to Disabled Person - Word Version

(Example)

Responsible to:

Employer's Name.

Location

Area in which the post will be based (e.g. Belfast, Bangor, Lisburn etc).

Closing date

Applications should be in no later than __________

Applicant's details

Name (Mr/Mrs/Ms)_______________________

Address _______________________________

______________________________________

Post Code _____________________________

Telephone _____________________________

E-mail ________________________________

Do you hold a current driving license? Yes/No.

Do you have access to a car? Yes/No.

Employment record

Please list your employers, and details of the position held, starting with the most recent and include any periods of unemployment.

Employer:_______________________

Nature of Position:_______________

From - To:_________________

Reason for leaving:________________

Experience and skills

There are no formal qualifications necessary for this post. Please use the space provided below to explain what relevant experience and skills you could bring to this post. You may continue on a separate sheet if necessary.

Motivation

Please state briefly why you applied for this post.

Other relevant Information

Please use the space below to provide any relevant information in support of your application.

Hobbies and interests

Please use the space provided to list any hobbies or interests that you have.

References

Please list details of two referees (one of whom should be your most recent employer).

Referee One

Name ____________________

Address __________________

Address __________________

Postcode _________________

Telephone (daytime) ________________

Referee Two

Name ____________________

Address __________________

Address __________________

Postcode _________________

Telephone (daytime)________________

May I contact your referees prior to any offer of employment? Yes/No.

Rehabilitation of Offenders (Exceptions) Order (NI) 1979

You are not normally on application for employment, required to declare information about convictions that are 'spent'. However, owing to the nature of the post for which you are applying, the above Order prohibits you from withholding information about such convictions.

Have you ever been convicted of a criminal offence? Yes/No.

If you answered 'yes' please give the nature of the conviction.

Completed application

You should return your completed application form by dd/mm/yy to:

Employer's name.
Employer's address/PO Box number.

Declaration

I declare that the information on this application is correct.

Signed ________________ Date _____________