Personal Assistant Zero hours
Age UK Rotherham Limited
Rotherham
Part-time
APPLICATION FOR EMPLOYMENT
Form AP2
PRIVATE AND CONFIDENTIAL
Return this form to: Operations, Manager, Age UK Rotherham, Eastwood Trading
Estate, Fitzwilliam Road, Rotherham, S65 2SL
Or email to: hannah.massey@ageukrotherham.org
Ref: PA Zero
POSITION APPLIED FOR
Personal Assistant Zero hours
Surname
Address
Forename(s)
Title
Postcode
Date of birth
NI No.
Telephone
number
Email address:
Current driving licence? Yes/No
Groups: Expiry Date:
Details of
endorsements
Are there any restrictions on you taking up employment in the UK? Yes No (please delete as appropriate)
(If yes, please provide details)
EDUCATION HISTORY
Schools Qualifications gained
Colleges/Universities Qualifications gained
Other training
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positions/PA Role/25 and Zero hours/APPLICATION FORM Personal Assistant Zero hours_2022.doc
OTHER EMPLOYMENT
Please note any other employment you would continue with if you were to be successful in obtaining this position.
EMPLOYMENT HISTORY (Please complete in full and use a separate sheet if necessary)
FROM - TO
NAME AND ADDRESS
OF EMPLOYER
JOB TITLE AND DUTIES
START/FINISH
SALARY
REASON FOR
LEAVING
Notice required in current post:
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positions/PA Role/25 and Zero hours/APPLICATION FORM Personal Assistant Zero hours_2022.doc
REFERENCES
Please note here the names and addresses of two persons from whom the company may obtain both character and work experience
references. (One must be from your most recent employer.)
1.
2.
LEISURE
Please note here your leisure interests, sports and hobbies, other pastimes etc.
CRIMINAL RECORD
Please note any criminal convictions except those 'spent' under the Rehabilitation of Offenders Act 1974. If none please state. In
certain circumstances employment is dependent upon obtaining a satisfactory basic disclosure from the Criminal Records
Bureau/Scottish Criminal Records Office.
GENERAL COMMENTS
Please detail here your specific reasons for this application, your main achievements to date and the strengths you would bring to
this post.
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positions/PA Role/25 and Zero hours/APPLICATION FORM Personal Assistant Zero hours_2022.doc
Have you had any periods of absence within the last three years? State length of absence and reason.
DECLARATION (Please read this carefully before signing this application)
1.
2.
I confirm that the above information is complete and correct and that any untrue or misleading information will give my
employer the right to terminate any employment contract offered.
I agree that the organisation reserves the right to require me to undergo a medical examination. (Should we require
further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to
inform you of our intention and obtain your permission prior to contacting your doctor). I agree that this information will
be retained in my personnel file during employment and for up to six years thereafter and understand that information will
be processed in accordance with the Data Protection Act.
3. I agree that should I be successful in this application, I will, if required, apply to the Criminal Records Bureau/Scottish
Criminal Records Office for a basic disclosure. I understand that should I fail to do so, or should the disclosure not be to the
satisfaction of the company any offer of employment may be withdrawn or my employment terminated.
Signed: Date:
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positions/PA Role/25 and Zero hours/APPLICATION FORM Personal Assistant Zero hours_2022.doc
EQUAL OPPORTUNITY MONITORING
Form EO
We are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable
treatment on the grounds of race, colour, ethnic or national origin, religious belief, political opinion or affiliation, sex, marital status,
sexual orientation, gender reassignment, age or disability, or is disadvantaged by conditions or requirements which cannot be shown to
be justifiable.
Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis
of their relevant merits and abilities.
All employees are given equal opportunity and are encouraged to progress within the organisation.
We are committed to an ongoing programme of action to make this policy fully effective. To ensure that this policy is fully and fairly
implemented and monitored, and for no other reason, would you please provide the following information:-
I would describe my ethnic group and sex as:- (please insert tick for your ethnic group and one tick for your sex)
A) White
English
Scottish
Irish
Welsh
Any other White background, please specify
B) Mixed
White and Black Caribbean
White and Asian
Any other Mixed background, please specify
White and Black African
C) Asian, Asian British, Asian English, Asian Scottish or Asian Welsh
Indian
Bangladeshi
Any other Asian background, please specify
Pakistani
D) Black, Black British, Black English, Black Scottish or Black Welsh
Caribbean
Any other Black background, please specify
African
E) Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh or other Ethnic Group
Chinese
Any other background, please specify
F) Sex
Male
Female
Name:
Date:
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positions/PA Role/25 and Zero hours/APPLICATION FORM Personal Assistant Zero hours_2022.doc