The Percy Hedley Foundation Station Road, Forest Hall Newcastle upon Tyne, ne12 8YY


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The Percy Hedley Foundation

Station Road, Forest Hall

Newcastle upon Tyne, NE12 8YY

Tel: 0191 2665491

Fax: 0191 2665537


Post reference number:

Application for the post of:

Contract applied for:

i.e. full time/ part time/ zero hours

Full Name:




Work: Home: Mobile:

National Insurance Number:

Education and Qualifications (including short courses)
School/College/Provider Course Details Date Obtained Results/Qualifications

Work related Training
Provider Course Details Date Obtained

Employment History

(Please give most recent first and explain any gaps in employment. Dates must be specified in format MM/YY)

Employer Occupation From/To Salary Reason for Leaving


Reasons for applying for this post: Please include full details of relevant experience or other information in support of your application. Please refer to relevant job description and person specification.

Please continue on a separate sheet if necessary.

Criminal convictions
Have you any criminal convictions? YES/NO (delete as appropriate)
If yes, give brief details on a separate sheet even if those convictions are ‘spent’. Successful applicants will be Disclosure and Barring Service checked. Failure to disclose information is considered to be gross misconduct.
A conviction will not necessarily be a bar to employment. A copy of The Percy Hedley Foundation’s policy on recruitment of people with a criminal record is available on request.

Work Permits:
Do you need a UK work permit to do this job under the terms of the asylum and Immigration Act 1996? Tick where appropriate.
No, I do not need a UK permit 
No, I have a UK training and work experience permit 
Yes, I need a UK work permit 
Where applicable please give details of any permit held -

Do you consider yourself to be a disabled person? YES/NO (delete as applicable)
If YES, please give details including any support you might need to enable you to access the interview should you be shortlisted.

References: Please give details of two people whom we may contact for a reference. One referee should be your present or most recent employer.

Job Title:

Telephone No:


Work / Personal (please delete)

Job Title:

Telephone No:


Work / Personal (please delete)

I confirm that the information I have given on this form is correct and complete, and that misleading statements may be sufficient for cancelling any agreements made. I understand that, in the event of being shortlisted for interview, I will be required to complete a confidential declaration in respect of my health. Because of the nature of the duties the postholder will be expected to undertake, I also understand that the declaration will include details of any criminal convictions, cautions, reprimands and final warnings and other information which may have a bearing on my suitability for the post.

I understand that a Disclosure and Barring Service (DBS) Disclosure will be sought in the event of a successful application.

Signed: Date:


As an organisation using the Disclosure and Barring Service (DBS) Disclosure service to assess applicants' suitability for positions of trust, The Percy Hedley Foundation complies fully with the DBS Code of Practice and undertakes to treat all applicants for positions fairly. It undertakes not to discriminate unfairly against any subject of a Disclosure on the basis of conviction or other information revealed.

The Foundation is committed to the fair treatment of its staff, potential staff or users of its services, regardless of race, gender, religion, sexual orientation, responsibilities for dependents, age, physical/mental disability or offending background.

This policy on the recruitment of ex-offenders, is issued to all applicants at the outset of the recruitment process.
We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. We select all candidates for interview based on their skills, qualifications and experience.
Because the work of the Foundation is exclusively with children and vulnerable adults, all posts are subject to DBS checks. An enhanced disclosure is only requested after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. All application forms, job adverts and recruitment briefs will contain a statement that a Disclosure will be requested in the event of the individual being offered the position.
Where a Disclosure is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process. We request that this information is sent under separate, confidential cover, to a designated person within the Foundation and we guarantee that this information is only seen by those who need to see it as part of the recruitment process.
Unless the nature of the position allows the Foundation to ask questions about your entire criminal record we only ask about "unspent" convictions as defined in the Rehabilitation of Offenders Act 1974.

We ensure that all those in the Foundation who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex offenders, e.g. Rehabilitation of Offenders Act 1974.

At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.
We make every subject of a DBS Disclosure aware of the existence of the DBS Code of Practice and make a copy available on request.
We undertake to discuss any matter revealed in a Disclosure with the person seeking the position before withdrawing a conditional offer of employment.
Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offences.


Applicants are requested to tick the relevant boxes below to enable the Foundation to monitor its Equal Opportunity Policy. Monitoring is recommended by the Codes of Practice for the elimination of racial discrimination and for the elimination on the grounds of sex and marital status. This information is used for no other purpose, does not inform the interview procedure and will be treated as confidential.

Surname ……………………………… Forenames …………………………………
Post Applied For ……………………………………………………………………………

 Male  Female

 Single  Married  Separated  Divorced  Widowed

Do you consider yourself disabled?  Yes  No
If YES, please give details ……………………………………………………….

Please indicate your ethnic origin below

 Asian - British  Black- British

 Asian - Other  Black - African

 Bangladeshi  Black - Caribbean

 Chinese  Black - Other

 Indian  White - British

 Pakistani  White - Other

 Other Ethnic Group

Where did you see this post advertised? …………………………………………………………


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