Application form for the post of WORM Zone
Playworker
Please return completed application forms to Tom Waring, preferably via
email, tom@stnicks.org.uk. Alternatively please post a hardcopy to St Nicks
Environment Centre, Rawdon Avenue, York, YO10 3ST
Personal details
Forename
Title
Surname
Address
Postcode
Email
Evening telephone number:
Daytime telephone number:
Where did you hear about this post?
References
Please provide the name and address of two referees from whom we may
seek information regarding your suitability for employment. References
will not be sought until after the interview. If you are currently
employed one of the referees must be your current employer. Otherwise,
it must be your most recent employer. Family members, former or
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
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current partners and close friends are not acceptable as referees.
Reference 1
Name
Position
Organisation
Address
Email
Daytime tel
Relationship to
you
Reference 2
Name
Position
Organisation
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
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Page 2 of 9
Address
Email
Daytime tel
Relationship to
you
Health
Are there any health matters you feel may be relevant to this
application?
Yes / No
If yes, please give
details
Rehabilitation of Offenders Act
Have you ever been convicted of a criminal offence
Yes / No
If yes, nature of the
offence
(please give details of
any convictions on a
separate sheet)
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
Page 3 of 9
Date of conviction
Declaration
The information on this application form is true and correct to the best
of my knowledge and belief
Signed
Date
(The first three pages of this form will be separated from the main
application, & are not seen at shortlisting.)
Education (most recent first)
Please summarise education with qualifications gained
Dates
Course / Institution
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
Qualifications
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Training (most recent first)
Please summarise most relevant training with qualifications gained, if
any
Dates
Course / Institution
Qualifications
Employment History: current / most recent post
Name and Address of
Employer
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
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Start date
End date (if
appropriate)
Salary
(present/most
recent salary)
Hours per
week
Notice period
required:
Reason for
leaving (or
wanting to leave)
Brief description of Job and Main Duties:
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
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Details of previous employment
Dates
Employer
Job titles / main duties
Reason for
leaving
Voluntary/Unpaid Activities
Dates
Hours/weeks Organisation
Brief details of duties
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
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Personal Statement: Abilities, knowledge and experience relevant to this
post
Please give your reasons for making this application. You need to read
the job description and person specification carefully, then explain how
your skills, abilities, knowledge and experience fit this post. These may
have been gained through paid employment, voluntary/community
work, domestic responsibilities, spare time activities, training and
anything else you think is relevant to this post. Please give evidence and
practical examples of your achievements
St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
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St Nicks (registered charity ‘Friends of St Nicholas Fields’ 1153739)
Application form
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