Post Applied for

Preferred working arrangement Preferred working arrangement Full time Part time Job share

Title Title Mr. Mrs. Miss Ms Other

Full Name

Email Address

Daytime telephone number

Mobile

National Insurance Number

Do you require a work permit? Do you require a work permit? Yes No

Employment history (please list most recent first. Include permanent and temporary work, service with HM Forces, voluntary work and any work experience from leaving school). Name & Address (include nature of business), Date from/to, position with brief description of duties and salary, reason for leaving.

Gaps/Time breaks in employment. Please describe all time spent since leaving full-time education, full details should be given for any period not acconted for by full-time eployment, education and training. This would include e.g. unemployment or voluntary work. Please state this information in chronological order.

Education and qualifications. Name of school, college, university etc; Date From/To; subjects studied (with grades and year taken)

Training: This includes government training schemes, apprenticeships, short courses, projects and secondments. Please also include trade/professional training and give date of completion.

Do you hold a current Driving Licence? Do you hold a current Driving Licence? Yes No

State the type of licence you hold

Do you have any current endorsements? Do you have any current endorsements? Yes No

Please specify

Why are you applying for this job? (Please mention any specific skills or experience that meets the requirements of the job description and person specification. These skills may have been gained in relation to your current or previous employment, education, training, domestic activities, voluntary work or leisure interests.)

References: Please provide TWO out of the three references. One must be your present or last employer and another second emloyer. If you have not been employed previously, please provde academic and character references. (Name, address, telephone number, occupation, email address)

Have you ever been dismissed, or have you ever resigned in the face of a dismissal or warning? Have you ever been dismissed, or have you ever resigned in the face of a dismissal or warning? Yes No

Have you ever been the subject of any allegations in relation to the safety and welfare of children, young people and/or vulnerable adults, either substantiated, or unsubstantiated? Have you ever been the subject of any allegations in relation to the safety and welfare of children, young people and/or vulnerable adults, either substantiated, or unsubstantiated? Yes No

Give details

Have you everbeen convicted of a criminal offence? Have you everbeen convicted of a criminal offence? Yes No

Are there any alleged offences outstanding against you? Are there any alleged offences outstanding against you? Yes No

Please give details

Do you have relationship with any person employed by or connected with Sollar Professional Services or partnership? Do you have relationship with any person employed by or connected with Sollar Professional Services or partnership? Yes No

Please give details

I declare that the information given both on this application form and attached equal opportunitoes monitoring form is true and correct. I understand that any false or misleading information, or omissions of information concerning canvassing or crimina convictions may disqualify my application or may render my contract of employment, if I am appointed, liable to termination. I declare that the information given both on this application form and attached equal opportunitoes monitoring form is true and correct. I understand that any false or misleading information, or omissions of information concerning canvassing or crimina convictions may disqualify my application or may render my contract of employment, if I am appointed, liable to termination.

Job applied for

Job No. or Ref (if applicable)

Location

How did you learn about this vacancy?

Age

Date of birth

Gender Gender Male Female

Ethnic Origin Ethnic Origin White Bristish, Irish, Gypsy/Romany, Other white background Mixed White & Black, Caribbean white & black, African white & Asian, Other mixed background Black or Black British Caribbean African any other black Asian, Asian Bristish Indian, Pakistani, Bangladeshi,other mixed background Other ethnic groups chinese other

Do you require any special assistance in your daily role? Do you require any special assistance in your daily role? Yes No

Please describe

Religion Religion Christian Buddhist Hindu Jewish Muslim Sikh Other religion No religion Prefer not to say

Sexual Orientation Sexual Orientation Bisexual Gay man Gay woman/lesbian Heterosexual/Straight Other Prefer not to say