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Application Form

Staffordshire and West Midlands Community Rehabilitation Company is committed to equal opportunities in employment. We therefore welcome job applications irrespective of your gender, race, disability, religion, sexual orientation, ethnic or national origin, trade union activity and age.

Please complete all sections of this form accurately, as it forms the initial stage in the selection procedure. It is important that you read the guidance notes before completing this form.

The form should be PRINTED/TYPED or written in BLACK ink or ball point pen for photocopying. CVs and/or emails will not be accepted. Canvassing will disqualify applications.

If you have a disability which makes it difficult for you to complete the application form, please contact the Human Resources Department who will endeavour to make alternative arrangements for you.

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PERSONAL DETAILS (BLOCK CAPITALS PLEASE)

Forename(s): Surname:

Previously known as: Preferred title (Dr/Mr/Miss/Mrs/Ms):

Address:

Post Code: National Insurance Number (NI):

/ / / /

Home telephone number:

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Current full driving licence: Yes 0 No 0

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JOB SHARE

All jobs are open to job sharing unless indicated otherwise.

Do you wish to share this job? Yes 0 No 0

If yes, what are your preferred hours? (please specify)

Job Sharing is when two people divide the hours and duties of one full-time job. Patterns are normally Mon, Tues, Wed (am) or Wed (pm), Thurs, Fri, or all mornings or all afternoons. They receive the pay and benefits to the hours

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