Ulster Quaker Service Committee UQSC, Religious Society of Friends, Quakers, Northern Ireland

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Please complete this Application Form as completely as possible, stating clearly the dates you are available for.

About Yourself


Forename(s)
First Name by which you are known
Surname
Home Address
Address for correspondance (if different to Home Address)
Post Code
Your email address
Home Telephone Number
Work Telephone Number
May we telephone you at work?
Date of Birth (dd/mm/yyyy)

Work Experience

Please give details of posts you have held, starting with your current post.

Job 1

Date : From	Date : To	Final Grade or Salary


Employer Name & Address	Nature of employer's business	Job Title and brief description of duties.

Job 2

Date : From	Date : To	Final Grade or Salary


Employer Name & Address	Nature of employer's business	Job Title and brief description of duties.

Job 3

Date : From	Date : To	Final Grade or Salary


Employer Name & Address	Nature of employer's business	Job Title and brief description of duties.

Job 4

Date : From	Date : To	Final Grade or Salary


Employer Name & Address	Nature of employer's business	Job Title and brief description of duties.

Job 5

Date : From	Date : To	Final Grade or Salary


Employer Name & Address	Nature of employer's business	Job Title and brief description of duties.

Voluntary Work

Give details below of all Voluntary work you have been involved in.

Organisation	Position	Average time spent per day/week/month	Date : From	Date : To

References

Please give the names and addresses of two people whom we may contact for a confidential assessment of your suitability for this job. The first must be your present employer or, if unemployed your last employer. Other referees could be a previous employer, some other appropriate person unrelated to you, or if this is a first job application, your head teacher or college tutor.

Reference 1
Name
Address
Telephone Number
Occupation

Reference 2
Name
Address
Telephone Number
Occupation

General Information

Do you hold a current full driving license?
If so, for how many years?
Have you any dietary restrictions?
If appointed, when could you take up your duties?

Disclosure and Conviction

Please give details of any criminal convictions you have had which might relate in any way to the post for which you are applying. (Under the terms of the Rehabilitation of Offenders Act 1974, and the Rehabilitation of Offenders Act (Exceptions) Order 1975; and the Rehabilitatiol1 of Offenders (Northern Ireland) Order 1978 and the Rehabilitation (Exceptions) Order (Northern Ireland), you do not have to disclose information about certain convictions depending upon their seriousness and how long ago they were).

Background

Please tell us why your experience and skills make you a good candidate for this post. If you wish please include relevant aspects of your non paid work experience, voluntary activities or time spent in caring responsibilities at home.

Declaration

To the best of my knowledge, there is no reason in respect of my physical or mental health why I should not be able to carry out the tasks described for this post. I confirm that the information given on this form is correct and complete and that misleading statements may be sufficient grounds for cancelling any agreements made.

Voluntary Work : I understand that the Ulster Quaker Service Committee does not accept responsibilty for loss or damage to my personal property during my service.

Type your name here
Today's Date

By typing your name above and submitting this online form, you declare that the information that you have given is correct.