CONFIDENTIAL
APPLICATION FORM - CO-ORDINATOR
Please complete and return to the above address in the envelope provided.
SURNAME FORENAMES
Title (Mr/Mrs/Miss/Ms/Other)
ADDRESS
Post Code
Telephone No: Home:
Work:
Mobile:
At which of these numbers may we contact you?
REFERENCES
Please give details of two persons, other than family, who may be contacted to provide a reference. At least one of the referees should be able to comment on your current or recent employment. References will only be taken up for short listed candidates and current employer only if and when you are offered the post.
1. Name:
Address:
2. Name:
Address:
STATEMENT
I apply to join the staff of Road Victims Trust. I agree to complete a Criminal Records Bureau Disclosure Application Form if offered the post.
Signed: Date:
Road Victims Trust requires all prospective staff members to disclose all convictions including "spent" convictions, as this work is covered by the exemption order of 1975 relating to section 4(2) and section 4(3b) of the Rehabilitation of Offenders Act 1974
If you have any convictions please indicate (You will be asked for details at your interview. This information will be held in strict confidence.) Yes/No
For the following questions please continue on a separate sheet if necessary but please do not enclose a separate CV
1. Where did you see this post advertised?
2. Current or last employment - please give employer details, description of post and dates
3. Previous employment - please give employer details, role and dates
4. Please give details of any voluntary work experience, including role and dates
5. Details of your education from age 16 together with any qualifications
6. Please give details of your experience as a Counsellor/Therapist including details of qualifications, i.e. description, dates & level attained.
7. Please give details of your experience of personal therapy or counselling, including dates and frequency.
8. Please give details of your experience of working with bereavement and trauma.
9. Please give details of any experience you have of supervising others either in a counselling sense or in a management sense.
10. Please list any other skills and/or experience that you believe may be of particular relevance to this post
11. Details of any other professional qualifications and membership of professional bodies
12. Please tell us something more about yourself. (Again continue on a separate sheet if necessary.)
a) What has prompted your application?
b) What might you find personally challenging?
c) What is your personal interest in this post?
13. Anything else you would like to tell us about yourself?
14. If offered and accepted when would you be available to take up the post?
Thank you for your interest. We will be in touch with you shortly. If you would like more information please contact us. Road Victims Trust is committed to ensuring that minority and disadvantaged groups are positively welcomed and involved in all aspects of Road Victims Trust
