UPPER ANDERSONSTOWN COMMUNITY FORUM	

We are an equal opportunities employer		Position Applied For: 
Childcare Assistant 25hrs Flexible (Full-time & Part-time)

Title: 	
Surname: 

Telephone No.: 	
First Names: 

National Insurance No.: 
	
Address: 

Postcode:

Education:-	

Year	Examination	Subject	Result	

				

				

				

				

				
 
Employment History

                                                         

Present Position:

Dates of Employment 

To: ________________	From:  ____________

Name & Address of Employer:   __________________________________

_____________________________________________________________________

			

Brief Summary of Duties: 
_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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Other Positions Held:		

Employer & Address	Position	Duties
(Briefly)	Dates
From / To	Reason for Leaving	

	

	

	
Please specify how you meet the essential and desirable criteria for this post?	

	
Please include any information which may be relevant to this application?
(e.g. volunteer work, publications, courses attended etc.)	

	
Please include any further details regarding your work experience which is relevant to the main duties and responsibilities of the position?

	
Please name 2 referees at least 1 of whom must have knowledge of your present or most recent position and must be in a managerial capacity.  The U.A.C.F. reserve the right to approach any previous employer for a reference.  (Relatives should NOT be named as referees)

Name:  
___________                                                       Name:  ____________

Occupation: 
                                                                         Occupation:  

Address:                                                          Address:  

               _________________________                       ________________________

              __________________________                       ________________________

Postcode:  ______________________           Postcode:  ________________________

Daytime Tel No.:                                             Daytime Tel No.:             

Is there any reason why you cannot work in regulated activity? i.e. with children or vulnerable adults?

        YES                                                                           NO  

Please note:- a criminal record will not necessarily be a bar to obtaining a position with the Upper Andersonstown Community Forum

Declaration:-

I declare that the information on this form is true and complete.  I understand that any wilful mis-statement or omission renders me liable to dismissal if engaged.  I also understand that appointment is subject to receipt of satisfactory references and proof of qualifications.

Signature: _______________                                    Date: __________________