1. The
Krysalis
Project Harp
Place, 2 Sandy Lane,
Harp Place, 2 Sandy Lane,
Service Radford,
Coventry
Manager CV1 4DX
Tel: 02476230730
Application Web: www.krysalisproject.org
Email:
Form krysalismembers@aol.com
Page |1 The Krysalis Project Charity Number: 1095073

2. Harp Place, 2 Sandy Lane,
Radford,
Coventry
CV1 4DX
Tel: 02476230730
Web: www.krysalisproject.org
Email: krysalismembers@aol.com
Application for Employment
Please complete in type or black ink. Closing date:
Application for post of:
Personal details (in block letters if handwritten)
Surname Initials
Address
Telephone: Home Work
Mobile
Email Address
National Insurance Number
Do you have a valid UK driving licence? Yes No
Do you have access to a vehicle? Yes No
Are you fluent in any other language apart from English? Yes No
Please give details of languages
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3. Training undertaken & relevant qualifications
Course title Date Qualification/ level
Previous employment & relevant voluntary experience
(Please list below details of your last 10 years of employment history; starting from the most recent and
working backwards)
Employer’s Job title Duties & Salary Start Leaving date or Reason for
name responsibilities date notice required leaving
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4. Relevant skills & experience for the post
Please give your reasons for applying for the post, and any skills, experience and interests which you
could bring to the post. Note the tasks required to be undertaken by the post holder are detailed in the
job description/ person specification. In the initial comparison of applicants for the job, the information
supplied here will play a significant role in the selection process. It is therefore important that you
complete this section in as much detail as possible.
PLEASE DO NOT SEND A CV
What skills do you have to offer to the post for which you are applying?
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5. What experience do you have—either personal or work—that relates to mental health?
What do you feel that you could bring to this post, from personal interests/ life skills?
Please continue on a separate sheet if necessary, attaching it to the back of your application.
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6. Referees
Please give names and addresses of two referees, who should not be related to you. If you have been
employed in the last five years the first referee must be your most recent employer or line manager.
(*please delete as appropriate)
References will not be taken up until an offer of employment has been made.
*Employment/ Line Manager
Name
Address
Telephone Number
Position
Relationship
Name
Address
Telephone Number
Position
Time off due to illness
Please indicate the number of days absence you have taken due to illness during the
previous twelve months:
Equal opportunities
The Krysalis Project wish to ensure that we do not discriminate against ex-offenders. However Krysalis
Project is aware that we operate services where an ex-offender might be in a vulnerable position,
unless consideration of the person’s background has been made. For this reason we ask you to
complete the following section:
N.B. Offences which would be deemed as spent under the rehabilitation of offenders Act 1974 need not
be declared.
Have you ever been convicted of a criminal offence? YES NO
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7. If your answer was yes, please give details of date(s) of offence(s), nature of offence(s) and
sentence(s) passed:
PLEASE NOTE:
Offers of employment with the Krysalis Project are subject to satisfactory responses from references
and enhanced disclosure application to the Criminal Records Bureau. Should either of these be
returned unsatisfactorily following commencement of employment, the offer of employment may be
terminated with immediate effect.
I confirm that to the best of my knowledge the information given on this form is true and correct, and
can be treated as part of any subsequent contract of employment. It will form the basis of my personnel
folder and will be stored in a secure location if I am a successful candidate.
Signature Date
Please return completed form to:
The Krysalis Project,
Harp Place, Sandy Lane,
Radford, Coventry, CV1 4DX Or Email to: krysalismembers@aol.com
We will write to you on or before the closing date to inform you of your position regarding short listing for interview.
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