Job Application Form

Please complete the application as fully as possible. It is important to give as many details as you can since your application will be considered initially on the information you provide. Any information you give will be treated in strict confidence by the Association. However, you should be aware that the Association is registered under the Data Protection Act 1984. By law all information held on computer has to be disclosed if requested to bodies which have good reason for asking for this information - for example, the Inland Revenue or the Police. You also have a right to check what information the Association has about your application on computer, and have this amended if it is wrong. Should you require any assistance in completing the application form, please do not hesitate to contact the Association.

Confidentiality - All information given on this form will be treated in strict confidence.

Application for the post of:

YOUR DETAILS	Other Information
Name	Are you a car owner?	tick if yes
Address line 1	If not, do you have regular access to a car?	tick if yes
Address line 2	Do you hold a clean driving licence?	tick if yes
Town	Is your health good?	tick if yes
County	Please give dates and details of any health issues or disability:
Postcode
Home Phone
Mobile Phone
Email Address

If you do have a disability, please advise us of any special adjustments that you may require at interview:

Have you ever been convicted of a criminal offence? (declaration subject to the Rehabilitation of Offenders Act 1974)	tick if yes

Secondary and Further Education Please fill out the following - School/College - Dates From & To - Qualifications Gained


Professional Qualifications (include dates gained)


Career - Please give details of posts held Please fill out the following - Dates From & To - Post Held & Brief Details of Job - Name & Address of Employer


Relevant Experience Describe below the scope of your present job (or any previous job in a relevant field), together with examples of achievements and any experience relevant to the position for which you are applying:


Additional Information Please state your reasons for applying for this post and any other information that you wish to bring to the Association's attention in support of your application:


Additional Documentation If you wish to attach a copy of your latest C.V. or any relevant certificates (for professional qualifications) to compliment your application, you may do so by using the Browse facility below. Only one document of the following types can be attached: - Microsoft Word (.doc or .rtf), Adobe Acrobat (.pdf) or Text Files (.txt). Please Note: The application form must always be completed in full. Your C.V. alone cannot be accepted.

Referees Names and addresses of two referees. One of these preferably should be your present employer. Please state clearly if you do not wish us to contact them prior to interview.

Referee 1			Referee 2
Name			Name
Job Title (if relevant)			Job Title (if relevant)
Address line 1			Address line 1
Address line 2			Address line 2
Town			Town
County			County
Postcode			Postcode
Relationship to you (employer, family friend etc)			Relationship to you (employer, family friend etc)
Please indicate if you do not wish us to contact prior to interview?			Please indicate if you do not wish us to contact prior to interview?

Paragraph 2 of Schedule 1 to the Housing Act 1996 prohibits Associations from employing close relatives of Board Members and only allows them to employ close relatives of members of staff under certain conditions. If, therefore, you are related to a Board Member or a member of staff of this Association (or to someone who is no longer a Board Member or member of staff but who has been within the last 12 months), please state the name of the person and your relationship to him or her.

In order to enable the Association to deal with your on-line application for employment, please read the following statement. If you find yourself unable to agree, then you must not send this application and you should place a tick in the "No" box at the end of this application. If however, you unconditionally agree with the statement, you should place a tick in the "Yes" box which also appears at the end of this application, and you will then be able to send an application to the Association. For the avoidance of doubt, if you have ticked the "No" box the application will not be accepted by the Association.

I certify that the foregoing particulars are correct to the best of my knowledge and belief, and understand that the giving of incorrect information may result in my application being refused or cancelled.

Yes I agree and wish to send the application

No I do not agree and wish to cancel the application

Mid-Wales Housing Association Ltd., Bryn Aderyn, The Bank, Newtown, Powys, SY16 2AB

Company Registration Number - MS21416R | t: 01686 627476 | f: 01686 623195 | e: info@mid-walesha.co.uk

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