Challenge Events Fundraiser Application | Teesside Hospice

Employee/Volunteer Role Application

Please complete the form below to apply for the desired position.

Personal Details

Title

First Name

Surname

Email Address

Home Tel.

Mobile

Address

Town

County

Postcode

Country

Current Employment

Are you currently employed?

May we contact you at work?

Current employer address

Current employer town

Current employer county

Current employer postcode

Employer country

Position held

Date of joining (MM/YYYY)

Leaving date/Notice period

Current salary

Summary of current duties

Reason for seeking new employment

Previous Employer

Employer 1

Date from:

Date to:

Salary:

Previous employers address:

Previous employer town:

Previous employer county:

Previous employer postcode:

Previous employer country:

Position held, nature of work and reason for leaving:

Id:

Previous Employer 1

Employer 2

Date from:

Date to:

Salary:

Previous employers address:

Previous employer town:

Previous employer county:

Previous employer postcode:

Previous employer country:

Position held, nature of work and reason for leaving:

Id:

Previous Employer 2

Employer 3

Date from:

Date to:

Salary:

Previous employers address:

Previous employer town:

Previous employer county:

Previous employer postcode:

Previous employer country:

Position held, nature of work and reason for leaving:

Id:

Previous Employer 3

Employer 4

Date from:

Date to:

Salary:

Previous employers address:

Previous employer town:

Previous employer county:

Previous employer postcode:

Previous employer country:

Position held, nature of work and reason for leaving:

Id:

Previous Employer 4

Education and Qualifications

Previous School/College/University Attended 1

Name of place of study:

Date from (MM/YYYY):

Date to (MM/YYYY):

Qualifications gained, examinations passed, grades:

Id:

Previous School/College/University Attended 1

Previous School/College/University Attended 2

Name of place of study:

Date from (MM/YYYY):

Date to (MM/YYYY):

Qualifications gained, examinations passed, grades:

Id:

Previous School/College/University Attended 2

Previous School/College/University Attended 3

Name of place of study:

Date from (MM/YYYY):

Date to (MM/YYYY):

Qualifications gained, examinations passed, grades:

Id:

Previous School/College/University Attended 3

Previous School/College/University Attended 4

Name of place of study:

Date from (MM/YYYY):

Date to (MM/YYYY):

Qualifications gained, examinations passed, grades:

Id:

Previous School/College/University Attended 4

Membership of Professional Bodies

Organisation name

Registration number

Expiry date

Other membership/affiliations

Other Information

Do you have the right to take up employment in the UK?

Do you hold a full driving license?

If yes, do you have any current endorsements?

Do you have access to a car?

Have you previously applied to work at Teesside Hospice?

If yes, when was this and for what post?

References

Please give details of two references, one of whom must be your present or most recent employer. Your references must have known you for at least two years and not be family members

May we obtain a reference prior to offer of appointment?

Supporting Information

Please use the space below to say why you are interested in this post and to give us further details of your career, activities and personal interests which you think are relevant to your application. Shortlisting will be undertaken by comparing the evidence presented by you with the requirements of the post as described in the job description and person specification.

Please write here

Reference 1

Full name:

Address:

Town:

Postcode:

County:

Country:

Email:

Phone:

Relationship:

Id:

Reference 1

Reference 2

Full name:

Address:

Town:

Postcode:

County:

Country:

Email:

Phone:

Relationship:

Id:

Reference 2

Reference 3

Full name:

Address:

Town:

Postcode:

County:

Country:

Email:

Phone:

Relationship:

Id:

Reference 3

Reference 4

Full name:

Address:

Town:

Postcode:

County:

Country:

Email:

Phone:

Relationship:

Id:

Reference 4

Rehabilitation of Offenders Act 1974 (exceptions) Order 1975
(as ammended in 2013)

Do you have any convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance?

Motoring offences can be excluded if not relevant to the post. If you have answered “yes” above, please provide more details in the section below.

I certify that, to the best of my belief, the information I have supplied is true and complete. I understand that any false information or failure to disclose health problems or criminal convictions or prosecution pending, may disqualify me from employment or render me liable to summary dismissal.

Do you have any unspent criminal convictions or subject to any criminal registers/orders?

In order to protect the public, if the post you have applied for is exempt from certain provisions of the Rehabilitation of Offenders Act 1974. You will therefore be required to disclose all and any past or pending cautions or convictions, whether spent or otherwise, unless it is either a “protected caution” or a “protected conviction” under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of Justice website.

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Equality and Diversity

We, Teesside Hospice are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee or volunteer receives less favourable treatment because of age, disability, gender reassignment, marriage and civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

Our recruitment selection criteria and procedures (including the areas or media sources which are used in the recruitment process) are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities and that no applicant, volunteer or employee is disadvantaged by provisions, criteria or practices which cannot be shown to be justified.

We would like to use your data to ensure that this policy is fully and fairly implemented. We will use your data to compile statistics on the representation amongst our workforce of the categories listed. To use this information, we need your consent. Signing in the space below will indicate that you consent to your data being used for the purposes stated. You may withdraw your consent at any time by contacting HR - HRenquiries@teessidehospice.co.uk. Completion of this form is optional. Any responses you give will assist us in our commitment to equality, diversity and inclusion in the workplace. Your responses will be kept strictly confidential and will not be used in any decisions affecting you.

Equal Opportunities Monitoring

Which of the following best describes your gender?

Do you identify as trans?

If prefer to self-describe, please add here:

Is the gender you identify with the same as your gender registered at birth?

How would you describe your ethnic origin?

What is your martial status?

What is your age?

Date of birth (DD/MM/YYYY)

Disability or health condition?

If yes, does it affect your ability to work?

What is your religion or belief?

If other, please specify

How would you describe your sexual orientation?

If prefer to self-describe

Let's Keep in Touch

We are so pleased that you'd like to help local people with a terminal illness to live as well as possible, for as long as possible. Thank you. We're looking forward to keeping in touch with you by post and phone, sharing our news, events and appeals.

Please let us know if you're also happy to hear from us by email and text.

Yes, I would like to hear from you by email

Yes, I would like to hear from you by text

If you don't want to hear from us, or change your mind about how we contact you, please let us know. You can email marketing@teessidehospice.co.uk or call 01642 811145.

We'll always keep your details safe; we won't share them with any other organisations to use for their own purposes and we'll only use them in accordance with our privacy policy.

Thank you.