Job Application Form

Official information
National Insurance number*
If appointed, how soon could you take up the post?*
Have you had any previous contact, or do you have any current contact with the YMCA?*
- Yes
- No
If Yes, please give details
Do you hold a current UK driving licence?*
- Yes
- No
Immigration, Asylum and Nationality Act 2006
It is a criminal offence to employ persons whose status prevents them from working in the United Kingdom. Prior to appointment, you will be required to provide evidence of a passport or other documents on the approved list to satisfy YMCA East Surrey that the Immigration, Asylum and Nationality Act 2006 is being complied with.
Are you eligible to work in the United Kingdom?*
- Yes
- No
Do you require a work permit to work in the United Kingdom?*
- Yes
- No
If Yes, please give details

Education, training and development
Please list your academic and other relevant qualifications (and dates passed) starting with the most recent*
Please describe other relevant learning opportunities (eg. training courses)
Present or last employer
Employer's name and address
Position held
Date commenced
Date of leaving (if applicable)
Reason for leaving (if applicable)
Please give a brief description of your duties and responsibilities

Previous employment and experience
Please give details of previous paid employment
Job 1
Name of Employer: Position held: Start Date: Leaving Date: Duties: Reason for Leaving:
Job 2
Name of Employer: Position held: Start Date: Leaving Date: Duties: Reason for Leaving:
Job 3
Name of Employer: Position held: Start Date: Leaving Date: Duties: Reason for Leaving:
Other skills and experience
Please give details of any relevant skills or experience gained outside employment (e.g. through voluntary services)

Supporting information
Please detail how you personally meet the specification for this role (illustrating with examples from work, voluntary or life experiences) and state why you are applying for this job*
References
Please supply full contact details of two people who will provide a reference for you. One must be from your current or most recent employer or, if you are a full-time student, from your place of education. Please do not supply both from the same place of work or education. Referees may not be members of your family. If you were known by a different name, please also state this.
Referee 1
Name: Position: Address: Post Code: Email: Telephone No: In what capacity does this person know you?
May we contact this person now?*
- Yes
- No
Referee 2
Name: Position: Address: Post Code: Email: Telephone No: In what capacity does this person know you?
May we contact this person now?*
- Yes
- No

Personal declarations
The position for which you are applying involves contact with children and/or vulnerable adults and is exempt from the Rehabilitation of Offenders Act 1974 and all subsequent amendments (England and Wales). For these positions you are not entitled to withhold information about police cautions, "bind-overs", or any criminal convictions including any that would otherwise be otherwise considered "spent" under the Act.
Have you ever been convicted of any offence or "bound-over" or given a caution?*
- Yes
- No
If Yes, please give details
I understand that if my application is successful I will be required to obtain a DBS Disclosure at the appropriate level.*
- Yes
General Data Protection Regulation
Please note that it is our policy that all recruitment documents, including application forms, for unsuccessful applicants, are kept in secure conditions for a period of 12 months, after which they will be securely destroyed.
I give my consent for YMCA East Surrey to keep my data for up to 12 months for the purpose of recruitment to the role applied for and for consideration for any other suitable vacancies that may arise during this time.*
- Yes
If I accept employment with YMCA East Surrey, I consent to my personal information being held securely by the organisation for the purpose of the administration of my Contract of Employment.*
- Yes

Declaration (please read carefully)
I declare that the information I have given on this form is complete and accurate and that I am not banned or disqualified from working with children and/or vulnerable adults nor subject to any sanctions or conditions on my employment imposed by The Independent Safeguarding Authority, the Secretary of State or a regulatory body.
I understand that to knowingly give false information, or to omit any relevant information, could result in the withdrawal of any offer of appointment, or my dismissal at any time in the future, and possible criminal prosecution.
Your name*
Date (DD/MM/YYYY)*
Captcha

Job details