St Mary Magdelene Church,
Beaconview Road, West Bromwich, B71 3PJ

Please return this form to Fr David via email fatherdavid100@gmail.com

PART A: PERSONAL INFORMATION

Post applied for:	Community Choir Leader		

Family name (block capitals):	
	Title:		
Preferred name:	
	
Names in full (block capitals):	
	
Address:	
	
Phone (that we can use to contact you):	
	
Email:		
	
Are you eligible for work in the UK?	

PART B: EDUCATION & TRAINING
Based on the job description, list education, training, any relevant professional qualifications and membership of professional organisations. Please give dates.

PART C: EMPLOYMENT HISTORY

Starting with your current/most recent appointment, indicate what you have done in the last 10 years. Please include the contact name and full address of previous employers.

Name and address of employer	Start and leave date	Post held and brief description of responsibilities	Reason for leaving	

PART D: INFORMATION IN SUPPORT OF YOUR APPLICATION 

Looking at the person specification, give examples of how you meet the criteria. Examples can be taken from work, volunteering, community, extra-curricular activities etc . 

PART E: REFEREES

Name:		
Job title:		
Phone:		
Email:		
Address:		
How you know this person		

Name:		
Job title:		
Phone:		
Email:		
Address:		
How you know this person		

To the best of my knowledge and belief, the information supplied by me in each section of this form is correct.

Signed:		Date:		

STRICTLY CONFIDENTIAL

PART F: ADDITIONAL INFORMATION  

Disclosure of conviction(s) 

Applications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this job will not be taken into account. You are required to disclose any convictions, which are not ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974. For legal and accounting professions, you are required to disclose all convictions, including those that are ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974.

Have you been convicted of a criminal offence that is not spent? If yes, please give details of date(s), offence(s) and sentence(s) passed.

Signed:		Date:		

Disability – Equality Act 2010 
Please outline any reasonable adjustments you may need if invited to attend an interview. 

Signed:		Date: