Confidential Application Form

Confidential Application Form

Olivia Lind Haldorsson

Save the Children

Rue Montoyer 39

B-1000, Brussels, Belgium

olivia.lind@savethechildren.be

Fax: +32 (0)2 513 49 03

, Belg

ref no:

please return to: è

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* Please use a BLACK pen

Please read the cover letter, job description and child protection guidance note before completing this form

Position applied for: ..............................................................................................................................................
Surname ......................................................................	Title ....................	Forename(s) ...........................................................................................			Date of birth ........ / ........ / 19......
Full Address (where normally contactable)			Private Telephone (and times when normally available) No:..................................... Times:.......................................................................	Work Telephone (and times available if we may contact you) No:..................................... Times:............................... ..........................................

If successful, when could you take up your appointment?
How did you hear about this post? (If through the press, please state which publication)

REFERENCES

Please give details below of three people whom we may contact for references. References will be taken up if you are short listed unless you specify otherwise. At least 2 of these referees should have knowledge of you in a working environment, either paid or unpaid, and one should be your current / last employer. If you are a recent school / college leaver, please give appropriate school / college referees.

Previous surname (if necessary) for reference purposes: ...............................................................................................................

For office use only Taken up Received	Name	Occupation/ Job Title	Full Address	Tel No.



EO-Y/N

SURNAME:......................................................................

EMPLOYMENT

Please start with your present/last employment and work backwards

Dates From	To	Employers Name & Address	Job Title & main responsibilities	Salary	Reason for Leaving

Please continue on a separate sheet if necessary

Please give details of any relevant unpaid / voluntary work experience (continue on back page if necessary):

.....................................................................................................................................................................................................................................................

EDUCATION

Name & address of schools/ colleges/universities attended since the age of 16 to present

(state if full or part-time)

Dates attended

Qualifications & grades obtained

(i.e. CSE, BSC, Professional qualifications etc)

From

Please continue on a separate sheet if necessary

SURNAME:......................................................................

TRAINING & SKILLS

Training

Please give details of any courses or training you have participated in within the last five years (including dates and length of course etc).

Computer Skills

Please give details of your computer skills, including software you can use, experience with building and managing databases, producing electronical newsletter, and managing/updating websites

Language Skills

Please give details of any languages you can speak / write / understand:

HEALTH

A disability or health problem will not preclude full consideration of your application.

How many days have you been absent from work owing to illness in the last 2 years?.................................................................................................................................

DISCLOSURE OF CONVICTIONS

The responsibilities of this post/role do not require the postholder to have regular contact with children or young people but they may have infrequent contact, usually with different groups of children and young people.

Have you been convicted or has any action been taken against you in relation to child/children under 18 years of age? YES/NO

If the answer is “yes” please give details on a separate sheet. Save the Children reserves the right to make checks with relevant authority prior to the appointment of the successful candidate. A satisfactory records check is a condition of employment and failure to agree to the criminal records check will preclude you from consideration for the position

LEISURE ACTIVITIES (Sports, hobbies etc)

SURNAME:......................................................................

INFORMATION IN SUPPORT OF YOUR APPLICATION

In the space below, please give a brief statement in support of your application giving your reasons for applying. Please refer to the job description stating how your experience and skills match the person specification. This should include details of any relevant past experience (including voluntary work and any areas of special interest). Please continue on a separate sheet if necessary.

DECLARATION

I certify that all particulars given are correct and understand that should any false statement(s), omission(s) be made on this form Save the Children reserves the right of dismissal. I understand that employment with Save the Children is subject to receipt of satisfactory references and a satisfactory criminal records check.

Signature of applicant................................................................................................................... Date..............................................................................

Please return this application form and any attachments to the address stated on the top of the front page of this form.