CONFIDENTIAL APPLICATION FORM 

Section 1

Citizens Advice Mendip
Highfield House
Shape Mendip Campus
Shepton Mallet
BA4 5BT

Email your completed application to: Ianb@citizensadvicemendip.org.uk

Please refer to the Guidance Notes for Applicants before completing this application form.
We value diversity, promote equality and challenge discrimination. We encourage and welcome applications from suitably skilled candidates from all backgrounds. Members of the recruitment panel will consider information you provide against the person specification for the role to decide whether you will be shortlisted for an interview. It is therefore essential that you complete the form fully and that you clearly demonstrate how you meet each point on the person specification. Please note that CVs are not accepted.	
Candidate ref. number (for office use only):		
Position applied for	

Job title		Job reference		

Location		

Personal information and address for correspondence	
First name(s)		
Last name		
Address	
	
Postcode		
Telephone home		
Telephone work		
May we contact you at work?	Yes / No	
Mobile		
Email		
We will normally contact you by email, however, if you would prefer to be contacted using another method please let us know here: 

Entitlement to work in the UK	
To take up this post you must have the right to work in the UK.
Please note that Citizens Advice Mendip does not hold a sponsor licence and, therefore, cannot issue certificates of sponsorship under the points-based system.	

Criminal convictions	
Having a criminal record will not necessarily bar you from working for Citizens Advice Mendip – much will depend on the type of job you have applied for and the background and circumstances of your offence.  
For some posts, an offer of employment will be subject to a Disclosure and Barring Service (DBS) check. If this applies to the post for which you are applying, this will be noted in the application pack.
Please see Guidance Notes and Application Pack for further details.	
Have you had any previous convictions not regarded as spent under the Rehabilitation of Offenders Act 1974?   	Yes / No	
If YES, please provide details of the offence and the date of conviction.

References	
Please provide the names, addresses, telephone numbers and email addresses of two people who may be approached for references. One of these should be your present or most recent employer, the other could be someone who knows you in a work related, voluntary or academic capacity. Both referees should be able to comment on your suitability for the post applied for. References will only be taken up for successful candidates following interview.	
Referee 1		
Name		
Address		
Postcode		
Telephone		
Email		
In which context does this referee know you?		
Referee 2		
Name		
Address		
Postcode		
Telephone		
Email		
In which context does this referee know you?		

Section 2
Information, experience, knowledge, skills and abilities	
IMPORTANT INFORMATION	
It is essential that you complete this section in full. Please refer to the Guidance Notes for Applicants for further details.

●	Please explain and demonstrate how your experience, skills and knowledge meet the selection criteria for the post described in the Person Specification 
●	Please ensure that you address all the criteria on the person specification using the same order and numbers.

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13. 

14. 

Career history	
Please include your current / previous employment (including job training schemes), voluntary work, community activities, school placements, time caring for dependants etc. Please put in date order, starting with the most recent. (Continue on a separate sheet if necessary.)	
Employer’s name and address and type of business.	State position held and outline briefly the nature of the work and your responsibilities.	

	
	Dates:	From	To	
	Reasons for leaving:

	
	Dates:	From	To	
	Reasons for leaving:

	
	Dates:	From	To	
	Reasons for leaving:

	
	Dates:	From	To	
	Reasons for leaving:

Educational history	
Please give details of educational qualifications you have obtained from school, college, university etc.	
Subject	Level	Grade	

		

Professional development	
Please give details of any professional qualifications, including membership of any professional bodies and any job-related training that you have undertaken.	

Declaration	
Data Protection Statement: I consent to this information being processed and stored for the purpose of recruitment and selection at Citizens Advice Mendip, and if appointed, for the purposes of employment at Citizens Advice Mendip.

I confirm that to the best of my knowledge, the information I have provided on this application form is true and correct. I understand that if appointed on the basis of false information contained in this form, I may be summarily dismissed. 
	
If you are sending your application form by email, please mark this box ☐
(as a substitute for your signature) to confirm that you agree to the above declaration. 
	
Signed:	Dated: