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1. Job Title   
  As Advertised in   
2. Surname       
  First Name   
  Address (Correspondence)   

Telephone Number   


Date of Birth   


Please give details of present positions with brief description of duties.


Job Title   


Date of Appointment   

  Notice Period   

Main Duties and Responsibilities :


Previous appointments.  Also include any activities, not necessarily employment, where skills and experience were gained (e.g., voluntary work). Please give any Specific job related training e.g., NVQ


Employer / Agency                             

  Posts Held   

General Education Please state qualifications, subjects, grades and dates.


Qualifications e.g., Professional and Vocational


Please supply names and addresses, telephone numbers and occupations of three people who are willing to give you a reference.  At least one of these must be from your current or most recent employer.  Preferably all referees should be qualified to comment in relation to the job description.


Can these references be taken up immediately?

  Yes No
Ref No.1

  Yes No
Ref No.2

  Yes No
Ref No.3

Do you hold a full driving license and are not currently disqualified from driving?

Do you hold a full driving license and are not currently disqualified from driving? Yes No

Experience and reasons for applying for this post.


Due to the nature of the work for which you are applying, this post is exempt from The REHABILITATION OF OFFENDERS ACT 1974 by virtue of the Rehabilitation of Offenders Act 1974 (exemptions) order 1975.  You are required to disclose any information you may have regarding any convictions against yourself which you may otherwise consider ‘spent’ in relation to this application. Any such information will be treated in the strictest confidence and used only in consideration of the suitability of your application.

  This post is subject to a full CRB enhanced disclosure.
Have you ever been convicted of any criminal offences? Yes No
  If yes please give details.

Medical Declaration:  

Are you fit to carry out the work as defined in the job description and person specification?

Yes No
  How many periods of sickness have you taken from work in the last two years?
  Do you have and illness or medical conditions that we should know about?

Information for applicants.

  • You will receive no further information unless you have been selected for interview.   If you have not been contacted within two weeks of the closing date, you must conclude that  you have been unsuccessful.   If yo require acknowledgement of receipt please enclose a stamped addressed envelope.

  • All offers of employment will be subject to references that are satisfactory to Wigan Link.  At least one of these must be from your current or most recent employer.  Also a full clear ENHANCED CRIMINAL DISCLOSURE.

  • Wigan Link strives towards being an Equal Opportunities Employer.

Thank you for the interest you have shown in this position.


To the best of my knowledge and belief all the particulars I have given are true.

I understand that any false statements may disqualify me from employment or render me liable for dismissal. I also understand that no offer of employment to me will be binding unless confirmed in writing.

Wigan Link, Office Bay, Office G15, Unity House, Westwood Park Drive, Wigan, WN3 4HE
Tel: 01942-597237  Fax: 01942-254003  Email: