Youth Worker application form

	Date from	Date to	Name of school/college/university	Qualifications gained
1	1, Date from:	1, Date to:	1, Name of school/college/university:	1, Qualifications gained:
2	2, Date from:	2, Date to:	2, Name of school/college/university:	2, Qualifications gained:
3	3, Date from:	3, Date to:	3, Name of school/college/university:	3, Qualifications gained:
4	4, Date from:	4, Date to:	4, Name of school/college/university:	4, Qualifications gained:
5	5, Date from:	5, Date to:	5, Name of school/college/university:	5, Qualifications gained:
6	6, Date from:	6, Date to:	6, Name of school/college/university:	6, Qualifications gained:

	Name of Training / course	Duration	Date obtained
1	1, Name of Training / course:	1, Duration:	1, Date obtained:
2	2, Name of Training / course:	2, Duration:	2, Date obtained:
3	3, Name of Training / course:	3, Duration:	3, Date obtained:
4	4, Name of Training / course:	4, Duration:	4, Date obtained:
5	5, Name of Training / course:	5, Duration:	5, Date obtained:
6	6, Name of Training / course:	6, Duration:	6, Date obtained:
7	7, Name of Training / course:	7, Duration:	7, Date obtained:
8	8, Name of Training / course:	8, Duration:	8, Date obtained:
9	9, Name of Training / course:	9, Duration:	9, Date obtained:
10	10, Name of Training / course:	10, Duration:	10, Date obtained:

Employment history

	Name and address of employer	Date from	Date to	Job title and brief description of main duties and responsibilities	Salary	Reason for leaving
1	1, Name and address of employer:	1, Date from:	1, Date to:	1, Job title and brief description of main duties and responsibilities:	1, Salary:	1, Reason for leaving:
2	2, Name and address of employer:	2, Date from:	2, Date to:	2, Job title and brief description of main duties and responsibilities:	2, Salary:	2, Reason for leaving:
3	3, Name and address of employer:	3, Date from:	3, Date to:	3, Job title and brief description of main duties and responsibilities:	3, Salary:	3, Reason for leaving:
4	4, Name and address of employer:	4, Date from:	4, Date to:	4, Job title and brief description of main duties and responsibilities:	4, Salary:	4, Reason for leaving:
5	5, Name and address of employer:	5, Date from:	5, Date to:	5, Job title and brief description of main duties and responsibilities:	5, Salary:	5, Reason for leaving:
6	6, Name and address of employer:	6, Date from:	6, Date to:	6, Job title and brief description of main duties and responsibilities:	6, Salary:	6, Reason for leaving:

Suitability for this post

Please Note: We will seek to match the information you provide against the job description / person specification. Therefore, you should ensure that you address each point identified in the job description / person specification and provide evidence of relevant experience and skills, including areas other than paid work.

DBS Information

The post you are applying for may be subject to an order under Section 4(4) of the Rehabilitation of Offenders Act 1974, as amended by the Protection of Freedom Act 2012.

Applicants are therefore not entitled to withhold information about convictions which, for other purposes are spent under the provisions of the Act. If you are to be recommended for the post, you may be subject to a Disclosure and Barring Service check. This will be an Enhanced Disclosure.

You must, therefore, disclose any convictions, cautions, warnings, reprimands, binding over or other orders, pending prosecutions or criminal investigations. Failure to disclose this information could result in the withdrawal of a job offer, dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application for positions to which an order applies.

References

	Reference 1	Reference 2
Name	Name, Reference 1:	Name, Reference 2:
Position	Position, Reference 1:	Position, Reference 2:
Work relationship	Work relationship, Reference 1:	Work relationship, Reference 2:
Organisation	Organisation, Reference 1:	Organisation, Reference 2:
Dates employed (to/from)	Dates employed (to/from), Reference 1:	Dates employed (to/from), Reference 2:
Address	Address, Reference 1:	Address, Reference 2:
Postcode	Postcode, Reference 1:	Postcode, Reference 2:
Telephone number	Telephone number, Reference 1:	Telephone number, Reference 2:
Email	Email, Reference 1:	Email, Reference 2:

Declaration

I confirm that the information provided in this application is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file.

Town Clerk & Responsible Finance Officer application

Education & Training

Employment history

Suitability for this post

DBS Information

References

Declaration

Equal Opportunities Monitoring