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Embed code for: Alzheimer_s_Society_Application_Form_2
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Please complete this form in black ink or black type.
A Curriculum vitae will not be accepted. Application number (Internal use only)
Post applied for: Vacancy no. VAC_ _ _ _ _ Location:
First name: Last Name: Email: Primary Tel No:
(Please indicate if this is a textphone number)
(If you are shortlisted, we may contact you by phone.) Secondary Tel No: Home address inc. post code:
Present or last post
Employer: Main duties and responsibilities: Address:
Position held: Current salary: Date started: Date left (if applicable): Reason for
Previous posts (most recent first)
Position held: Date started: Date left:
Other previous posts (please continue on a separate sheet if necessary)
Education, qualifications and training
Please note: where a specific qualification is an essential requirement in the person specification you will be required to produce original certificates if you are offered the post.
Qualification or course Place of study Date completed Grade achieved (if applicable):
Please give the name and addresses of two referees. One must be your current or most recent employer, or tutor if you are a student or school leaver. Please note references from personal friends or relatives are not acceptable.
Current or most recent employer Name Name
May we contact this referee if you are shortlisted? May we contact this referee if you are shortlisted? Yes No Yes No
Do you have any unspent criminal convictions? Yes No (If yes, please give brief details)
Please note: If the post for which you have applied is exempt from the provisions of the Rehabilitation of Offenders Act 1974, you will be required to complete a criminal records check (through the Disclosure and Barring Service in England and Wales, or AccessNI in Northern Ireland).
Are there any restrictions on your right to work in the UK? Yes No If ‘yes’, please specify: Are you connected to a business which trades with Alzheimer’s Society? Yes No If ‘yes’, please state relationship and business:
Are you related to or a partner of an Alzheimer’s Society employee? Yes No If ‘yes’, please state the name(s), relationship
and if an employee, their job title:
How did you hear about this vacancy?
Please specify which job board / social media site / newspaper / agency if applicable.
Please explain why you are applying for this post, stating your relevant experience and skills. Please refer to the job description and person specification and continue on a separate sheet if necessary.
Personal statement (continued)
I confirm that the details given in this form are correct and understand that any false declaration may result in disciplinary action being taken, which could result in my dismissal from post.
I hereby explicitly consent to Alzheimer’s Society holding my personal details within a manual or electronic filing system in relation to the Data Protection Act 1998.
To submit your completed application form, please refer to the advert for contact details of the recruiting manager.
Registered charity no 296645. A company limited by guarantee and registered in England no 2115499.
Vacancy no. VAC_ _ _ _ _ Location:
To submit your completed application form, please refer to the advert for contact d