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Heart of England Co-Operative Society Application Form

The Society welcomes all applications and will assess them solely in terms of their suitability for the job.
Please complete all sections necessary in the application form.

About the Vacancy

Position Applied For (please specify location) (required):

Notice required to leave present employer (required):

Please tick the type of job you require (required):
 Full-time Part-time Temporary Permanent

Please tick the days you are available to work (required):
 Monday Tuesday Wednesday Thursday Friday Saturday Sunday

What amount of hours would you be available to work each week?:


If offered a position with the Society would this be your only employment (required)
 Yes  No

Personal Information

Your Title (required)


Full first and middle names (required):


Last Name (required):


Full Address including postcode (required):


Email address (required):


NI number (required):


Daytime/Evening Telephone Number:


Mobile Telephone Number:

Do you have a valid driving licence? (required):
 Yes  No

Are you in receipt of a pension? (required):
 Yes  No

Do you have a student loan? (required):
 Yes  No

Do you have any current driving endorsements? (required)
 Yes  No

If Yes please give details:

Do you have any relatives or friends working for the Society? (required)
 Yes  No

If Yes please give details:

Education and Employment Information

Education

Name of School/ College:

Please advise of the qualification title, qualification subject and grade obtained in the section below:

Employment History

Please give details of all jobs held in the last 5 years including part-time and unpaid work, starting with your current or most recent employer.

Name of Employer 1:

Address of Employer

Employment Dates (From - To)

Job Title

Reason For Leaving

Name of Employer 2:

Address of Employer

Employment Dates (From - To)

Job Title

Reason For Leaving

Name of Employer 3:

Address of Employer

Employment Dates (From - To)

Job Title

Reason For Leaving

Name of Employer 4:

Address of Employer

Employment Dates (From - To)

Job Title

Reason For Leaving

Please explain any periods of non-employment since finishing full-time education.

References

If you have had any previous employment these must be your last two employers. Please note these must not be members of your own family.

Reference 1

Name:

Address:

Company and Occupation:

Relationship to you:

Contact Number:

Email Address:

Please select:
 Employment reference  Personal Reference

Reference 2

Name:

Address:

Company and Occupation:

Relationship to you:

Contact Number:

Email Address:

Please select:
 Employment reference  Personal Reference

Criminal Convictions

If you have been convicted of a criminal offence please give details below. Spent convictions as defined by the Rehabilitation of Offenders Act 1974 can be excluded. The Society reserves the right to carry out criminal records checks. Ex-offenders will be considered on their merits.
Dates and Offences:

Emergency Information

Please provide details of someone who can be contacted in the event of an emergency.

Name:

Address:

Postcode:

Relationship:

Telephone contact numbers

Daytime

Evening

Mobile

Eligibility to Work in the UK

If you are invited to attend an interview with the Society you will be required to provide original documentation, together with copies, that prove your right to work in the UK eg. UK or EEA passport etc. as per the list of approved documents below.

Click here for list of approved documents.

Equal Opportunities Monitoring Form

The Society is committed to the principle of equal opportunities and have active policies to avoid unfair discrimination. The Equal Opportunities Commission and the Commission for Racial Equality strongly recommend that such policies are monitored effectively and we fully support this. We would like to ask you a few questions, which will help us to monitor the operation of our Equal Opportunity Policy.
Any information given in this section will be held in strict confidence separately from your application form and will not be used in the selection process. We ask for your co-operation in completing this form. If you do not wish to complete a particular section then leave it blank.

Personal Information

Date of Birth:

Nationality:

Place of Birth:

Gender:  Male  Female

Ethnicity

Which of the following most adequately describes your ethnic origin?

 Asian  British Asian  Black  Black British  Chinese  Mixed race  Other Ethnic Group  Prefer not to say  White 

Religion

To which of the following religions, bodies or belief systems, if any, do you belong or affiliate to? Please select one.

 Buddhist  Christian (all denominations)  Hindu  Jewish  Muslim  None  Sikh  refer not to say  Other 
If other selected then please state.

Disabilty


The Disability Discrimination Act 1995 defines a 'disabled person' as a person with 'a physical or mental impairment, which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities'.

Would you consider yourself to be disabled?
 Yes  No

Special Arrangements

If you consider yourself to have a disability for which we need to make special arrangements in order for you to attend an interview, please provide details.

Validity: I declare that the information given on the Application Form is true to the best of my knowledge and belief, I understand that if it is subsequently discovered that any statement is false, misleading or cannot be substantiated that I may be discharged from employment by the Society.

 I have read and agree the Data Protection Rules and the Conditions of Appointment

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