King’s Church Amersham
Application Form for Facilites Co-ordinator
If you run out of space when completing any of the questions, please feel free to continue on a
separate sheet of paper (remembering to note which question you have continued) and
attach this securely to your application.
Personal Details
First names: ………………………………………
Surname: …………………………………
Date of Birth: ……………………………………
Age in years: ……………………
Home address: ……………………………………………………………………………………
……………………………………………………
Postcode: …………………………………
Marital status: ……………………………………
Telephone (day): …………………………… Telephone (evening): ………..………….………
Training - Give information regarding any courses etc that is relevant to the job
Employment
Please give details of your current post, or if you are not currently employed, your most recent
post. Please outline your main tasks, responsibilities and achievements.
Date of starting: ………………………………. Date of leaving if you have left: ……………
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Please give details of previous posts held:
Job title: …………………………………………. Employer: ………………..…….…….……
Date started: …………………………………….. Date left: ………………………………….
Reason for leaving: ……………………………………………………………………………….
Job title: …………………………………………. Employer: …………………..….…….……
Date started: …………………………………….. Date left: ………………………………….
Reason for leaving: ……………………………………………………………………………….
Other Relevant Experience - Please give details of other relevant. This can be either in a paid or
voluntary capacity.
Qualities - Please outline why you feel drawn to this post, and the qualities you feel you could
bring.
Any Other Information - Please use the space below to give any further information which you
feel would support your application.
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Declaration
Do you suffer, or have you suffered any illness which may affect your work
Yes / No
If yes, please give details.
References - We ask that one referee is someone who has known you well in a personal
capacity for at least five recent years, and that the other referee has known you in a work
context (this does not necessarily need to have been paid employment - it may be in a
voluntary context). We will be asking your referees to provide a written reference and we may
also wish to speak to them.
Referee 1
Name and title: ……………………………………………………………….…...
Address: …………………………………………………………………………..
……………………………………………………………………………………..
Telephone (day): …………………………. (evening): ………………………….
How long has this referee known you? …………………………………………...
In what capacity does this referee know you? …………………………………….
Referee 2
Name and title: ……………………………………………………………….…...
Address: …………………………………………………………………………..
……………………………………………………………………………………..
Telephone (day): …………………………. (evening): ………………………….
How long has this referee known you? …………………………………………...
In what capacity does this referee know you? …………………………………….
Police Check - We will be asking the person we wish to appoint to undertake a Police Check.
Appointment will be subject to this being undertaken satisfactorily. For the purposes of the
police check and due to the nature of the post any convictions which would normally be
‘spent’ must be declared (Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975,
Section 4(ii).
Have you ever been charged with or convicted of a criminal offence; or are you at present the
subject of criminal investigations?
Yes / No
If yes, please give brief details including the nature of the offence(s) and dates:
The details I have given in this application are to the best of my knowledge true and accurate.
Your Signature: ………………..………………………………. Date: …………………………….
Please send or email your application form to Paul.Lynch@kingschurchamersham.com or Paul Lynch,
Kings Church, Raans Road, Amersham, Bucks, HP6 6LX
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