Post Applied For:

Reference No:

Location:

Preferred Title (Mr, Miss, Mrs, etc.): Surname:
First Name (s):
Address:

Home!or" Tel:

Mo#ile Tel No.:

Post $ode:

Education and Training
Sc%ools,$olle&es,'ni(ersit), etc. *ates From + To ,ualifications &ained

-t%er trainin& and courses attended #ot% in and outside .or" .it%
/ualifications or mem#ers%ip of professional #odies, etc.:
*ates

Re&istered Address : 00 1ast Street, Ha(ant, Hants, P-2 3AA. 4 5 P Re&istration Num#er 62207R
A member of The Guinness Partnership
Current employment
1mplo)er8s name, address
and nature of #usiness
Post %eld and #rief
outline of duties
Salar), reason for lea(in&
and notice re/uired
*ates
From + To

Previous employment (Please start with the most recent)
1mplo)er8s name, address
and nature of #usiness
Post %eld and #rief
outline of duties
Salar), reason for lea(in&
and notice re/uired
*ates
From + To

Please demonstrate #elo. %o. )our s"ills and e9pertise meet at least t%e essential re/uirements for t%e post )ou
%a(e applied for. 4n doin& t%is )ou s%ould consider t%e cate&ories and re/uirements outlined on t%e enclosed Person
Specification:
: 1ducation Standard : 19perience : S"ills 5 ;no.led&e
: P%)sical Re/uirements : An) ot%er re/uirements or details )ou feel ma) #e rele(ant









($ontinue on a separate s%eet of paper if necessar).)
3. *o )ou %old a current dri(in& licence< =es No
4f )ou %a(e an) endorsements please pro(ide details


6. *o )ou re/uire a .or" permit to .or" in t%e ';< =es No
4f )es please pro(ide details


0. Ha(e )ou e(er %eld or applied for a post .it% t%e >uinness
Trust<


4f )es please &i(e details, .it% dates


'nder Sc%edule 3 of t%e Housin& Act (322?) .e are o#li&ed to o#tain @oard Aut%orisation s%ould )ou #e
related to an) mem#er of >uinness $are and Support staff or a @oard Mem#er. 4f t%is is t%e case please
pro(ide us .it% t%eir name and t%e nature of t%e relations%ip.



Please &i(e names, current addresses and telep%one num#ers of at least t.o referees. One of these must be
your current employer and together they should cover the last two years of your employment.
3.




6.




Tel:

Tel:

Relations%ip to Referee (e&. past emplo)er, collea&ue, etc.)

APlease note references .ill onl) #e ta"en up .it% )our permission. 4f )ou are appointed, references .ill #e "ept on
)our personal file.
4 understand t%at failin& to pro(ide rele(ant information or pro(idin& false or inaccurate information could (if 4 am
appointed) lead to disciplinar) action or dismissal.
I give consent for Personal Data divulged in applications and forms for employment to be kept on files (both
manual and computer for recruitment! monitoring and employment purposes" Information #ill be stored
securely in line #ith the Data Protection Act $%%&"


'igned( Date(

A member of The Guinness Partnership
Furt%er information can #e found on ###"guinnesstrust"org"uk
E)ual *pportunities
Ref. No: Post:
Name:

>uinness $are and Support %as committed itself to an 1/ualit) 5 *i(ersit) Polic). T%is means t%at all Bo# applications
.ill #e considered on t%eir merits, .it%out re&ard to t%e race, colour or national ori&in of t%e applicant, t%eir reli&ious
#eliefs, se9, a&e, se9ual orientation or disa#ilit).
!e do %o.e(er need to s%o. t%at .e are implementin& t%is polic). !e .ould t%erefore as" )ou to &i(e us some
indication of %o. )ou .ould descri#e )our et%nic ori&in. T%is information .ill #e used on a statistical #asis onl) (ie. .e
.ill "eep a record of t%e num#er of applicants from (arious et%nic &roups for eac% post ad(ertised). 4t is totall) confidential
and .ill #e considered separatel) from )our application. 4f )ou are appointed, t%e information .ill #e used t%rou&%out )our
emplo)ment on a statistical #asis onl).
!%at is )our reli&ion<
None $%ristian @udd%ist Hindu Ce.is%
Muslim Si"% -t%er *o not .is% to ans.er
!%at is )our et%nic &roup<
!%ite: @ritis% !%ite: 4ris% !%ite: -t%er Mi9ed: !%ite 5 @lac" $ari##ean
Mi9ed: !%ite 5 @lac" African Mi9ed: !%ite 5 Asian Mi9ed: -t%er $%inese
AsianAsian @ritis%: 4ndian AsianAsian @ritis%: Pa"istani AsianAsian @ritis%: @an&lades%i
AsianAsian @ritis%: -t%er @lac"@lac" @ritis%: $ari##ean @lac"@lac" @ritis%: African
@lac"@lac" @ritis%: -t%er *o not .is% to ans.er -t%er (please specif))
!%at is )our se9ual orientation<
Heterose9ual >a) or Les#ian @i+se9ual -t%er *o not .is% to ans.er
>ender: Male Female *ate of @irt%: Nationalit):
For monitorin& purposes, do )ou consider )ourself to #e disa#led< =es No
4f )ou do %a(e a disa#ilit) .%ic% ma) affect )our .or", please &i(e details in order t%at t%e appropriate support
ma) #e pro(ided:


Are t%ere an) reasona#le adBustments .%ic% )ou feel s%ould #e made to t%e recruitment process to assist
)ou in )our application for t%e Co#<


Ho. did )ou find out a#out t%is position<


4 &i(e consent for Personal *ata di(ul&ed in applications and forms for emplo)ment to #e "ept on files (#ot%
manual and computer) for recruitment, monitorin& and emplo)ment purposes. 4nformation .ill #e stored securel)
in line .it% t%e *ata Protection Act 322D.

Si&ned: *ate:
Re&istered Address: 00 1ast Street, Ha(ant, Hants, P-2 3AA. 4 5 P Re&istration Num#er: 62207R
Declaration of Criminal +ecord , strictl) pri(ate and confidential
>uinness $are and Support .elcomes applications from e9+offenders as part of its e/ual opportunities polic) and a criminal
record .ould not necessaril) #e a #ar to o#tainin& a position. Ho.e(er, it is important t%at .e c%ec" .%et%er )ou %a(e #een
con(icted of a criminal offence (ot%er t%an a spent con(iction under t%e Re%a#ilitation of -ffenders Act 327E) .%ic% ma)
affect )our suita#ilit) for t%is post.
T%is information is not passed to t%ose s%ortlistin&, .%ic% is purel) #ased on )our a#ilit) to do t%e Bo#. 4f )ou are s%ortlisted
)ou ma) #e contacted to discuss an) rele(ant information on t%is form to ensure it is possi#le for )ou to #e considered for t%e
post. T%e inter(ie. panel ma) .is% to discuss t%is furt%er .it% )ou if )ou are offered an inter(ie..
Please complete this form
Ha(e )ou e(er #een con(icted of a criminal offence or
&i(en a formal reprimand, final .arnin& or caution #) t%e police<
4f )es, please pro(ide details
*ate of -ffence Nature of -ffence Sentence or nature of Police Sanction










NB: Failure to declare a current conviction may disqualify you from employment or result in summary dismissal
when the dishonesty comes to light.
4s t%ere an) ot%er non+con(iction information (e&. pendin& prosecution) .%ic% ma) %a(e a #earin& on )our
suita#ilit) for t%is post<


4 &i(e consent for Personal *ata di(ul&ed in applications and forms for emplo)ment to #e "ept on files (#ot%
manual and computer) for recruitment, monitorin& and emplo)ment purposes. 4nformation .ill #e stored
securel) in line .it% t%e *ata Protection Act 322D.

Si&ned: *ate:
-orking #ith children or vulnerable adults
Please note that anyone offered a post that re)uires #orking #ith children or vulnerable adults #ill be
asked to apply for a Disclosure from the Criminal +ecords .ureau! in addition to any information provided
above" Any offer #ill be conditional on a satisfactory Disclosure and you #ould receive a copy of this"
Furt%er information a#out t%e *isclosure Sc%eme can #e found on ###"disclosure"gov"uk" A cop) of >uinness
$are and Support8s polic) on emplo)in& people .it% a criminal record is a(aila#le on re/uest.
Re&istered Address: 00 1ast Street, Ha(ant, Hants, P-2 3AA. 4 5 P Re&istration Num#er: 62207R
=es No