Position applied for(*):

Name(*):

Address(*):

Telephone(*):

Email:

Age:

Date of Birth:

EDUCATION/QUALIFICATIONS AND TRAINING

Qualification/Training 1:

Date obtained/Attended:

Qualification/Training 2 :

Date obtained/Attended:

Qualification/Training 3:

Date obtained/Attended:

Qualification/Training 4:

Date obtained/Attended:

Qualification/Training 5:

Date obtained/Attended:

PRESENT OR MOST RECENT EMPLOYMENT

Please give full details of your previous jobs with the most recent first.

Most Recent Job

Position:

Salary:

Start Date:

End Date:

Reason for leaving:

Who did/do you report to:

Name of Employer:

Address of Employer:

Previous Job

Position:

Salary:

Start Date:

End Date:

Reason for leaving:

Who did/do you report to:

Name of Employer:

Address of Employer:

Previous Job

Position:

Salary:

Start Date:

End Date:

Reason for leaving:

Who did/do you report to:

Name of Employer:

Address of Employer:

EXPERIENCE AND SKILLS

Before completing this section please read the enclosed specification and guidance notes carefully. Referring to each requirement listed in the person specification; demonstrate how you meet the requirement by giving relevant details of your experience, skills and knowledge gained in employment, voluntary work and elsewhere.

GENERAL INFORMATION

Do you require a work permit? YESNO

If you have answered YES above, please give details:

Have you ever been convicted of a criminal offence? YESNO

If you have answered YES above, please give details:

Are you related to any of the Co-Operative staff or Committee Members? YESNO

If you have answered YES above, please give details:

Do you have any other jobs or commitments, or do you work in a voluntary capacity? YESNO

If you have answered YES above, please give details:

REFERENCES

First Reference

Name:

Position:

Organization:

Address:

Telephone:

Email:

Second Reference

Name:

Position:

Organization:

Address:

Telephone:

Email:

Are we able to take up references now? YESNO

AVAILABILITY

What notice do you have to give?

When are you not available for an interview?

DECLARATION

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in termination of employment or withdrawal of the job offer.