Application Form
Parts 1 and 2 will be detached and are not considered for shortlisting purposes.
Please complete in black ink as this form will be photocopied
Private and Confidential
Job Title: Job Ref No:
Project/Dept:
Location: Closing Date:
PART ONE – PERSONAL DETAILS
Title: Ms / Miss / Mrs / Mr / Dr / Other Date of Birth:
Forename(s): Surname: (block letters)
Address:
Contact Details
Home Telephone: ( ) Mobile Telephone:
Work Telephone: ( ) Ext Email:
May we telephone you at work? Yes No
Do you need a work permit to work in the UK? Yes No
Are you related to any staff, council member or client of the Richmond Fellowship? Yes No
References
Please provide details of two people who are not related to you to provide references. Referee’s should be able to comment on your suitability for the
job, and one of these must be your present or your last employer. If you have been out of the workforce for some time, please provide details of people
who can comment on your suitability for this post and indicate why this is the case.
Current/Last Employer Second Referee
Name: Name:
Position Held: Position Held:
Address: Address:
Telephone: ( ) Email: Telephone: ( ) Email:
Referees will only be contacted if you are successful at interview and prior to commencing employment with the Richmond Fellowship. Employment is
offered subject to the receipt of satisfactory references.
FOR PERSONNEL USE ONLY: Candidate Ref No: Job Ref. No:
Develop with Richmond Fellowship
PART TWO - DISCLOSURE OF CONVICTIONS STATEMENT
You will appreciate that the Richmond Fellowship, being responsible for the provision of services to people with mental health and addiction
problems, must be particularly careful to enquire into the background of applicants for posts which involve working with these vulnerable groups.
This post is exempt from Section 4 (2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974
(Exceptions) order 1975 and require that you declare any convictions or cautions you may have, with details and dates, even if they would
otherwise be regarded as “spent” under the Act.
If this post is subject to receipt of a satisfactory Enhanced Disclosure from the Criminal Records Bureau this will be indicated within the applicant
cover letter.
Please Note: The information you give will be treated in confidence, only taken into account in relation to this particular application and
destroyed if you are not successful. The disclosure of a criminal record will not necessarily debar you from appointment unless the Director
concerned considers that the conviction renders you unsuitable for appointment. Please refer to the Richmond Fellowship Policy on the
Recruitment of Ex-offenders for further information.
Please tick as applicable and sign below:
I have no convictions/cautions to declare
I have convictions/cautions to declare and have detailed these below
Details of Convictions and/or cautions to be declared:
Date: Details:
Declaration
I confirm that the information I have submitted in Parts 1-6 and on any additional sheets is correct and complete. I understand that, if successful,
it will be treated as the basis of my contract of employment and that any misleading statement may be sufficient grounds for dismissal or for
cancelling any offer of employment made.
As part of this application I give the Richmond Fellowship / Richmond Fellowship Employment & Training permission to collect, retain and process
information about me, such as age, gender and ethnic origin. This information will only be used to allow the organisation to monitor compliance
with the law and best practice in terms of equal opportunity and non-discrimination.
Signature:
Print Name: Date:
FOR PERSONNEL USE ONLY: Candidate Ref No: Job Ref. No:
PART THREE - TRAINING AND PROFESSIONAL DEVELOPMENT (Please give dates)
Location Professional development and training completed (including From To
and Address grades/qualifications gained, membership of professional bodies and (date) (date)
registration/PIN numbers). Also state type of study (i.e. Full or Part time)
It is the Richmond Fellowship’s policy to check all professional qualifications
PART FOUR – PREVIOUS EMPLOYMENT
Current/Most Recent Employer
Job Title: Name of Employer:
Department: Current Salary £ per annum
Address of Employer:
Dates of Employment: From: To: Period of Notice required? weeks
Reason for Leaving/wishing to Leave:
Brief description of duties and responsibilities:
FOR PERSONNEL USE ONLY: Candidate Ref No: Job Ref. No:
Previous Employment History
Please state most recent employment first and include time spent in voluntary work/caring for others.
From To Job Title and Main Responsibilities Employer and Reason for Leaving
(date) (date) type of business
PART FIVE – OTHER DETAILS
All applicants who have a disability and meet the criteria for the job will be interviewed.
Do you consider yourself to have a disability Yes No
Have you any health problems that a prospective employer should be aware Yes No
If YES, please give details below
How many days have you been absent from work due to illness in the last 2 years? days
PART SIX - SUPPORTING STATEMENT OF APPLICATION
Statement of Interest
Please outline your main interest in working for the Richmond Fellowship and in this particular post.
Suitability for the Post
Please describe your suitability for the post with particular reference to the criteria in the Person Specification. Include all relevant
skills, knowledge and experience (including paid and un-paid work experience and time spent in caring responsibilities at home).
Continue overleaf if necessary
FOR PERSONNEL USE ONLY: Candidate Ref No: Job Ref. No:
Additional space for continuations where space provided is insufficient:
If necessary continue on a maximum of 2 additional A4 sheets.
Checklist:
Have you completed and enclosed Section B? - Equal Opportunities Monitoring Form? Yes No
Have you attached any additional A4 sheets used (maximum of 2)? Yes No
Have you signed the declaration on Page 2? Yes No
The form should then be returned to:
The Personnel Department, Richmond Fellowship, 80 Holloway Road, Highbury & Islington, London N7 8JG.
RECRUITMENT AND EMPLOYMENT
Equal opportunities
The Richmond Fellowship is committed to ensuring that
every stage of its recruitment and selection process is
fair and that everyone is treated equally and helpfully,
even if not appointed. If you think that you have been
treated unfairly in some way please contact the
Personnel Department and your complaint will be
investigated.
A summary of our Equal Opportunities Policy in relation
to recruitment and employment is included below:
The Richmond Fellowship is committed to monitoring
and reviewing its selection criteria and procedures on a
regular basis, in order to ensure that individuals are
selected, employed and treated during recruitment and
employment on their relevant merits and abilities. All
employees undertake training in equal opportunities as
provided by the organisation, and where appropriate
special training is given.
In practice this means that:
No applicant, employee or volunteer shall be placed at a
disadvantage by requirements or conditions that are
unnecessary for that level or type of work
No applicant, employee or volunteer, who is able to
meet the requirements and conditions necessary for that
level or type of work, shall receive less favourable
treatment than any other on the grounds of race, colour,
ethnicity, gender, sexual orientation, marital status,
AIDS/HIV status, disability, age or history of mental
health problems or addiction.
Employees or volunteers from disadvantaged groups are
provided with additional training and support, as
identified through the appraisal system, to achieve
equality of opportunity within the organisation.
All applicants for jobs will be monitored regarding
ethnic origin, gender, age, disability and history of
mental health or addiction problems, and the progress
of employees within the organisation reviewed.
This policy will cover the following areas:
Recruitment of new staff and volunteers
Transfer and promotion of existing staff and volunteers
Conditions of service of existing staff and volunteers
The Personnel Department, Richmond Fellowship,
80 Holloway Road, Highbury & Islington, London N7 8JG.
RICHMOND FELLOWSHIP
EQUAL OPPORTUNITIES MONITORING FORM
The Richmond Fellowship is committed to working towards
equal opportunities and we select staff solely on merit
irrespective of race, colour, national or ethnic origin, gender,
sexual orientation, marital status, age, social class, religious
belief, disability or history of mental health or addiction
problems. The following questions will enable us to monitor the
effectiveness of our Equal Opportunities Policy. The sheet will
be detached from your other details on arrival (if you prefer
you may send it separately) and used solely for statistical
monitoring purposes. It will be treated as strictly confidential
and not used in the selection process at any stage.
Name: Ref No:
Job Title:
How did you hear of this job?
Website Other Please specify
Sex: Male Female
Age Group (Please Note: The Richmond Fellowship has a retirement age of 65)
Under 25 25-34 35-44 45-54 55-65
ETHNIC GROUP
Choose one from A to E, then tick the appropriate
box to indicate your cultural background.
A: White 1 British
2 Irish
3 Any other White background
(please write in)
B: Mixed 1 White & Black Caribbean
2 White & Black African
3 White & Asian
4 Any other Mixed background
(please write in)
C: Asian or
Asian British 1 Indian
2 Pakistani
3 Bangladeshi
4 Any other Asian background
(please write in)
D: Black or
Black British 1 Caribbean
2 African
3 Any other Black background
(please write in)
E: Chinese or other
ethnic Group 1 Chinese
2 Any other
(please write in)
Do you consider that you have a DISABILITY?
Yes No
Do you have a history of MENTAL HEALTH/
ADDICTION problems? Yes No
Thank you for your co-operation in completing this form
Such monitoring is recommended by the Commission for
Racial Equality and the Equal Opportunities Commission
