Osmani Trust

Application for Employment

Job Title:
Post Reference:

It is important that you read the guidance notes before completing this application form. Please fully complete this form using type or BLACK ink and CAPITAL letters. A curriculum vitae is not an acceptable form of application unless stated otherwise. Applications received after the closing date will not be considered.	Return the completed application form to: Shelim Shakir Health Trainer Project Manager Osmani Centre 58 Underwood Road London E1 5AW Telephone: 020 7247 8080 Fax: 020 7247 6453 Email: Shelim.shakir@osmanitrust.org

The information you supply on this form will be treated in confidence

Personal Details:

First Name :

Last Name :

Address:

Post Code:

Home Telephone:	Daytime Telephone:

Mobile Telephone:	Nat. Insurance No:

Email Address:

Date of Birth:	Male:	Female:

Are you able to take up employment in the UK with no current immigration restriction	Yes:	No:

Dates not available for interview:

If these dates clash with the interview date we will try to re-arrange but cannot guarantee to do this

Current or most recent employment/ voluntary work

Employer :

Job Title :

Address:

Post Code:

Current/ Last Salary:	Benefits:

Date Commenced:	Date of Leaving:

Reason for Leaving:

Period of Notice:

Brief description of main duties & responsibilities: Use separate sheet if necessary.

Previous Employment of Work Experience Record

Please provide full details of all your previous paid and unpaid employment in date order since leaving full time education, explaining any breaks. Use separate sheet if necessary.

Name of employer, and nature of business:

Position held, duties and responsibilities:

Length of service:

Name of employer, and nature of business:

Position held, duties and responsibilities:

Length of service:

Name of employer, and nature of business:

Position held, duties and responsibilities:
Length of service:
Educational Qualifications & Training obtained from schools/ colleges/ universities

Name of Schools, Colleges, Universities etc:

Name of Course:

Dates from – to:

Qualifications and Grades obtained:

Name of Schools, Colleges, Universities etc:

Name of Course:

Dates from – to:

Qualifications and Grades obtained:

Name of Schools, Colleges, Universities etc:

Name of Course:

Dates from – to:

Qualifications and Grades obtained:

Other relevant qualifications or records of achievements

Please provide details of any other relevant qualifications or records of achievement (e.g. courses attended), including membership of professional bodies. Please note, if you are appointed we will need to see your original qualification. Use separate sheet if necessary.

Professional Qualifications:

Qualifications and/ or Grades obtained:

Dates from – to:

Level of Achievement:

Personal Statement

Abilities, skills, knowledge and experience

Please use this section to explain in detail how you meet all of the requirements of the Person Specification and why you consider yourself suitable for the post. This should include all aspects of your education and experience, including paid or voluntary work, study or training that are relevant to this position. Use separate sheet if necessary.

References
Please give the name and addresses of two people who are willing to provide references relating to your work experience and suitability for the post you have applied for. One must be your present or most recent manager. Please note that we reserve the right to approach any of your previous employers for a reference.

Reference 1:

Name :

Job Title :

Address:

Post Code:

Organisation:	Telephone:

Work Relationship:

Email Address:

May we approach them at this stage?

Yes:	No:

Reference 2:

Name :

Job Title :

Address:

Post Code:

Organisation:	Telephone:

Work Relationship:

Email Address:

May we approach them at this stage?

Yes:	No:

Declarations Health Please state number of days you have been absent from work due to sickness in the past twelve months: How many periods of absence does this represent? Driving Licence Details The enclosed post details will state whether a driving license is required for the post. Do you hold a full, clean, current licence If yes, please state the type of licence: which enables you to drive in the UK? Yes: No: If successful you will be required to provide evidence of your licence before your appointment.

Criminal Convictions

Due to the nature of the work undertaken by Osmani Trust and the fact that our key beneficiaries are children and youth, we will undertake Criminal Records Bureau Disclosure on all applicants.

Do you have any criminal conviction(s) or police cautions(s)? (Spent or Unspent)	Yes:	No:

If ‘YES’, please complete the following:

Nature of offences :

Date of Conviction:

Sentence imposed:

If ‘YES’, please complete the following:

Nature of offences :

Date of Conviction:

Sentence imposed:

In the last three years, have you had a Criminal Records Bureau Disclosure undertaken?	Yes:	No:

If yes please state the CRB reference number:

CRB Reference	Date of
Number:	Application:

If successful you will be required to provide evidence of your CRB Disclosure before your appointment

OSMANI TRUST

Employment Monitoring

Osmani Trust has an equality and diversity policy and is keen to ensure that the policy is working effectively. The information you provide will be treated in the strictest confidence and will only be used for statistical monitoring and is not used as part of the interview selection process.
About You:

Last Name :

Post Code :

Where did you see this job advertised?

Are You:	Male:	Female:

A Tower Hamlets Residents:	Yes:	No:

Applying for:	Full-time:	Part-time:

Ethnicity:
White	Asian
English	Bangladeshi
Irish	Chinese

Scottish	Vietnamese
Welsh	Indian
Other	Pakistani
Please Specify	Please Specify

Black	Mixed or Dual Heritage
Caribbean	White and Asian
African Somali	White and Black African
Other African	Other Mixed Background

Please Specify	Please Specify

Languages:	Religion/Belief:
Do you speak any of the following languages?	What is your religious belief?
Bengali	Yes	No	Christian
Chinese	Yes	No	Hindu
Somali	Yes	No	Jewish

Other (specify)	Muslim
Other (specify)

Sexual Orientation:
How would you define your sexual orientation?
Bisexual
Gay
Heterosexual
Lesbian
Decline to state

Disability:
Do you consider yourself to be disabled?
Yes	No
Hearing Impairment
Learning Disability
Mental Health Issue
Physical Disability
Other (specify)

Age:
Date of Birth:
Certification:
I certify that all information given in this information is correct to the best of my knowledge. Details of qualifications and work experience may be checked with the organisation and authorities concerned. I understand that, if I conceal any information, or information provided is untrue, and I have been employed, then my contract may be terminated,
Signature: ______________________________	Date: __________________

‘Ordinary People Doing Extraordinary Things’

Osmani Trust Osmani Centre 58 Underwood Road London E1 5AW (t) 020 7247 8080 (f) 020 7247 6453