APPLICATION FOR EMPLOYMENT

Alternative Futures Group’s mission is ‘to work creatively with people and their aspirations to make positive things happen in a challenging world – people fully

living their lives’- helping others to achieve their aspirations could help you achieve yours.

Please complete in black ink or type – all sections must be completedPlease use a tick as appropriate when answering ‘yes’ ‘no’ questions

Post Applied For Locations (Please specify as appropriate)

Reference Number Closing Date

How did you hear about this vacancy?

PERSONAL DETAILS

Surname: First Name:

Previous Name (if applicable):Current Address:

Post Code:

Home Tel No: Mobile:

Email Address: Work Tel No:Can we contact you at work?

National Insurance Number:

Do you hold a current, full Driving Licence: Yes No

ASYLUM AND IMMIGRATION ACT 1996Are you legally authorised to work in this country?

Yes No Do you require a work

permit?Yes No

If ‘yes’ please state expiry date __ __ / __ __ / __ __

Does your permit have any restrictions?

You will be required to produce your passport and/or other proof of your entitlement to work in the UK should you be invited for an interview.

Only original documents are acceptable.

AFG Website Job Centre Plus Newspaper AFG Internal Vacancy Word of Mouth AFG Employee (specify name) Other (please specify)

ASSOCIATIONS WITH ALTERNATIVE FUTURES GROUPAre you a close personal friend or relative of any person associated with Alternative Futures Group, such as any employees, trustees, suppliers, contractors, etc? If ‘yes’ please provide details here:

DISABILITYUnder the Equality Act 2010 people with a disability or a health condition are entitled to ‘reasonable adjustments’ during the recruitment process.Please let us know in writing separately to this application form if you require any reasonable adjustments, due to disability, to enable you to attend an interview/Assessment Centre, or which you wish us to take into account when considering your application.Reasonable adjustments are things like different coloured paper for reading material, larger text, altering the time of the interview, or making the interview room accessible for you. If you would like to discuss your requirements further, please contact in confidence the Recruitment Team on 0151 4824005.

CURRENT EMPLOYMENT(please provide details of your present employment (if applicable)

Name, Address, Tel No. of Present Employer

Date of Employment

FromJob Title Job Responsibilities Salary/

Grade Reason for Leaving

Notice required/remaining in current job

EMPLOYMENT HISTORY(please list your full previous employment – most recent first (please continue on a separate sheet if necessary)

Name, Address, Tel No. of Previous Employer(s)

Date of EmploymentFrom To

Job Title Job Responsibilities Salary/Grade Reason for Leaving

Please continue on separate sheet if necessary

PROFESSIONAL QUALIFICATIONS, MEMBERSHIP(S) AND REGISTRATION

Professional BodyQualification/Grade/

Membership/NMC/ISA Registration

Expiry/Renewal Date Registration/Membership Number

Please provide full details of why you think you should be considered for the position applied

for. Please demonstrate how you meet the requirements of the job description/person specification by giving examples as follows:

Skills and Knowledge:

Values and Attitudes:

Experience:

Please provide an example of a challenge you have encountered as a manager and what did you learn from this experience?

Please provide an example of a time when you believe you have been particularly successful as a manager. Include details of what you learnt from the experience?

Please tell us why you feel you will be successful in this role?

Please continue on additional sheet(s) if required

REFERENCESYou must provide a minimum of two references. At least one of which should be your current or most recent employer (unless this is not applicable – see below). Employment references must cover continuous employment for the previous 24 months. Referees must not be a relative. Alternative Futures Group reserves the right to contact any of your former employers.Upon offer of employment, please confirm that Alternative Futures Group can contact your referees listed below

Yes No

Referee 1 Referee 2Name: Name:Job Title: Job Title:Relationship to Referee:(eg Line Manager, previous boss etc)

Relationship to Referee:(eg Line Manager, previous boss etc)

Company: Company:Address: Address:

Tel No: Tel No:

Email Address: Email Address:Referee 3 Referee 4

Name: Name:Job Title: Job Title:Relationship to Referee:(eg Line Manager, previous boss etc)

Relationship to Referee:(eg Line Manager, previous boss etc)

Company: Company:Address: Address:

Tel No: Tel No:

Email Address: Email Address:

CRIMINAL CONVICTIONSPosts are exempt from the provisions of Section (42) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. You are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provision of the act and in the event of employment any failure to disclose such convictions could result in disciplinary action or subsequent dismissal from employment.Have you had any criminal convictions? Yes NoIf ‘yes’ please give details:

Date Court Nature of Offence Penalty Imposed

Details of driving licence endorsements, if any:

Alternative Futures Group meet the requirements in respect of exempt questions under the Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a Criminal Record Check from the Criminal Records Bureau/Disclosures England before appointment is confirmed. This will include details of cautions, reprimands or final warnings as well as convictions.

DECLARATIONI declare that to the best of my knowledge that the information I have given on this application form is correct. I understand that any false or misleading information given may result in the withdrawal of an offer of employment, or in my dismissal if appointed.

I agree that if appointed to a position within the company, this information will be retained in my personnel file during my employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.I understand that, in the event of being short-listed for interview, I will be required to complete a confidential declaration in respect of details of any criminal convictions, cautions, reprimands and final warnings and any other information which may have a bearing on my suitability for the post.I understand that an Enhanced Disclosure may be sought in the event of a successful application and that if appointed any false statement later revealed may result in disciplinary action against me, including dismissal.

Signature Date

DATA PROTECTION STATEMENTThe information given to Alternative Futures Group will be processed only by Alternative Futures Group for the purpose of considering your application for employment. If you are successful in your applicable, this form and any information contained within it will be retained on our records for the duration of your employment and for up to 6 years after the end of your employment.

When completed please return this form to:Human Resources Department

Lion Court, Kings Drive, Kings Business ParkPrescot, Knowsley, L34 1BN

YOUR DIVERSITY – CONFIDENTIAL Please use a tick as appropriate

HELP US TO HELP YOU We are committed to providing equality of opportunity for all people. Individuals will be selected,

promoted and treated according to their abilities and merits and job requirements. We are committed to ensuring that disabled applicants who meet the minimum requirements of the

vacancy will be interviewed. One of our most important ways of making sure that we are fair is by collating and monitoring

information relating to both external and internal candidates that apply to us for jobs, and those who are successful in obtaining appointments.

To help us check the effectiveness of our policy, you are asked to complete this section of the application form, but it is not compulsory. This information will be treated as strictly and used only for

monitoring purposes.

WHAT INFORMATION ARE WE LOOKING FOR? We need different kinds of information for different reasons. We ask about ethnic origin, gender, age and whether or not your consider you are disabled, so that we

can check how closely the numbers of people who apply to us for jobs, or who gets jobs with us, match up to the local population.

This enables us to check the effectiveness of our recruitment processes and allows us to check that they are fair and equally open to everyone.

DISABILITYUnder the terms of the Equality Act 2010, a person has a disability if she/he has physical or mental impairment, which has a substantial and long-term adverse effect on her/his ability to carry out normal day-to-day activities.Do you consider yourself to have a disability? Yes No

ETHNIC GROUPWhite – British Asian or Asian British – BangladeshiWhite – Irish Asian or Asian British – Other BackgroundWhite – Other Background Black or Black British – CaribbeanMixed – White and Black Caribbean Black or Black British – AfricanMixed – White and Black African Black or Black British – Other BackgroundMixed – White and Asian Chinese or Ethnic Group – ChineseMixed – Other Background Chinese or Ethnic Group – Other BackgroundAsian or Asian British – Indian Other – please stateAsian or Asian British – Pakistani Prefer not to say

SEXUAL ORIENTATION – how would you describe your sexual orientation?Heterosexual Homosexual OtherBisexual Prefer not to say

RELIGIONYes No Describe

SEXMale Female Transgender

AGE RANGE18 – 25 26 – 35 36 – 45 46 – 60 60 +

MARITAL STATUSSingle Marrie

dDivorced Separate

dWidowed

Other