APPLICATION FORM
Post applied for						      

							

  						         
	
1.  Personal Details 
Surname						      Initials

  							         
Address 					

  							        Tel mobile   

     Tel home    

               Email         

National  Insurance number

 											

2.  Education and vocational qualifications 

School/University/College
	
Course Title	
Subjects studied	
Qualification and date awarded	

				

        

3.  Your membership of professional bodies

Name of Awarding Body/Institution	
Class of Membership	
Date attended	
Qualification	

		

		

4.  Training courses attended which may be relevant to this application

Course provider
	
Description of Course (including main subjects covered)	
Date awarded	

			

5.  Current employment (or most recent employer)

Name and Address of Employer	
Job Title	
From 	
To	

				

Please give details of your present duties / responsibilities using supplementary sheet(s) if required.

	

6.  Previous employment

Please provide details of your employment history (excluding current post), starting with the most recent post.  You should include any periods of unemployment.

Name and Address of Employer	
Job Title and Brief Description of Duties	
Dates
Starting          Leaving	
Reason for leaving	

				

7.  Ability to meet essential criteria for the post
Using the Person Specification please outline how your skills and experience meet the criteria for this post.  You must demonstrate that you have the required skills and give examples to illustrate this (use continuation sheets as necessary).

	

8.  Personal Statement in Support of Application
Please state your reason(s) for applying for this post

	

9.  Driving Licence

		          		
Do you hold a full and current driving licence?		Yes		No				

			

Do you have use of a car?					Yes		No	

10.  Disability

Epilepsy Scotland offers a guaranteed interview to any applicant who considers him/herself to be disabled and who meets the minimum essential requirements for the post.

	Please tick if you consider yourself to be disabled.

If you require any facilities/assistance if you are invited for interview, please give details below.

	

12.  Referees
Please provide details of two referees who can comment on your suitability for this position, one of whom must be your most recent employer.  Relatives, friend or partners are not appropriate referees.

Name	
Address	
Occupation	

	

Email:
Tel No.	

	

	

Email:
Tel No.		

Referees will only be approached if an offer of employment is made.

13.   Declaration
I certify that all statements given above by me on this form are true and correct to the best of my knowledge.  I realise that if I am employed and it is found that such information and any other documents associated with the recruitment and selection process is false or that I have withheld information I am liable to dismissal without notice.

Signed: 							Date:

14.   Returning your application
Completed application forms should be returned by the closing date to:

Helen Hollywood
Epilepsy Scotland
48 Govan Road
Glasgow
G51 1JL

Telephone 0141 427 4911

Email: hhollywood@epilepsyscotland.org.uk

www.epilepsyscotland.org.uk