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HACKNEY HEALTH HUBS
New Kingshold Receptionist Application Form
Personal details
First name:
Last name:
Address:
Postcode:
Daytime telephone number:
Email address:
How to apply
Please return your completed application form, accompanied by a completed Equal
Opportunities Monitoring Form, no later than 4pm on Monday 27th April 2015:
 By email to info@hackneyhealthhubs.org.uk with the reference ‘HHH4’ in the
subject line; or
 By post to Shoreditch Trust, 8 Orsman Road, London N1 5QJ
A blank Equal Opportunities Monitoring Form is available on the Shoreditch Trust website,
alongside the Job Description and Person Specification, at
www.shoreditchtrust.org.uk/about-us/jobs.
If you have any queries, contact Edouard Guidon on 020 7033 8506 or
edouard@shoreditchtrust.org.uk.
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Employment and volunteering history
Tell us about your relevant employment and volunteering history, giving your current/most
recent position first. Please ensure that you provide all the information requested.
Employer
Job title/
volunteer role
Duties and responsibilities
From /To
Reason for leaving
2
Relevant qualifications or records of achievement
Please provide details of any relevant qualifications or records of achievement (for example
courses attended). Please note that we may ask you for your original qualifications if you are
appointed.
Training organisation/
accreditation body
Qualification
Grade obtained (if
relevant)
From /To
Educational qualifications and training obtained from schools, colleges and universities
Establishment or organisation
Name of course
Grade obtained
From /To
3
References
Please provide details of at least one work referee from your present or most recent place
of work; the second may be a personal referee (but not a relative or friend) who can
comment on your suitability for the job. Referees will only be contacted if you are successful
at interview and prior to commencing employment with Shoreditch Trust. Employment is
offered subject to the receipt of satisfactory references.
Referee 1
Name:
Address:
Postcode:
Telephone:
Email:
Position/relation to you:
Referee 2
Name:
Address:
Postcode:
Telephone:
Email:
Position/relation to you:
4
Declaration
Due to the nature of the work involved and the wide range of individuals that this project
will target (some of whom may have support needs), Shoreditch Trust must be careful to
enquire about any convictions or cautions that you may have. Please note that each
applicant will be considered on their own merits and having a criminal record will not
necessarily bar you from working with us.
Do you have any unspent convictions, cautions, reprimands or warnings?
Yes
No
If yes, please provide details and dates:
Are you eligible to work in the UK?
Yes
No
I declare that the information I have given in this application is accurate and true. I
understand that providing misleading, false information or significant omission may be
sufficient grounds for dismissal or for cancelling any offer of employment made.
Signature
Date
5
Personal statement
Please refer carefully to the job description and the person specification when completing
this section as your application will mainly be assessed on the answers you provide.
Continue on a separate page if you run out of space for any of the questions, making sure
that you reference the question that you are answering.
1. Your experience
1.1.
Essential experience: Please provide an outline of your professional or personal
experience that would enable you to meet the essential demands of this post.
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1.2.
Desirable experience: Please use this section to outline any experience that you
have gained through working, in a volunteer capacity or in your personal life,
which would complement your essential experience and make you suitable for
this role.
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2. Knowledge, skills and aptitudes
2.1.
Give an example of when you exceeded a customer’s expectations. Please
include the background to your example, what your job was, what you did to
deliver excellent customer care, how you know that you had exceeded the
customer’s expectations and what the outcome was.
8
2.2.
Please provide an example of when you have made a positive contribution to a
team, outlining the background to the example, what you contributed and what
outcome it led to.
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2.3.
Why do you think it’s important to consider different cultures, religions and
backgrounds when dealing with the general public?
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3. About you
Language
3.1.
Please use this section to tell us why you would be suitable for this post,
including any additional information that you think may be relevant.
3.2.
Do you speak any additional languages? Please rate each aspect on a scale of 1 to
5 where 1 means ‘not very confident’ and 5 means ‘very confident’.
Spoken
Reading
Writing
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