PARKINSON’S DISEASE SOCIETY OF THE UNITED KINGDOM

APPLICATION FORM
Curriculum Vitaes will not be accepted as part of, or instead of, this application form
Please return your completed application form to: Human Resources Department, 215 Vauxhall
Bridge Road, London, SW1V 1EJ or recruit@parkinsons.org.uk REF NO. (HR only)

Position Applied for Region/ Area (if applicable)

How did you hear about this post? (If through the press, please state which publication)

Title Mr, Mrs, Miss, Ms, Other (please Surname

state)
Forenames

Address

Post Code Email Address

Home Tel Work or Mobile Tel

Only answer if car driving licence and/or use of car is a requirement of role
Do you hold a current driving If required would you be Have you been convicted of any
licence? prepared to provide a car for motor offence(s) resulting in
work use? disqualification?
Yes No Yes No Yes No

Education and Training

Education
Subject Level/Qual Date Gained

Professional Membership Details

Training
Course level Course Provider Dates Duration
Employment

Please start with your present/last employment and work backwards (state if full/part time).

Dates Name and Job Title Main Responsibilities Reason for Leaving Final
From Address of Salary
To Employer

Please give details of any relevant unpaid/voluntary work experience (continue on back page if necessary).
Skills & General Information

This section is to give us specific information in support of your application. You must be able to
demonstrate on this application form and at interview, if called, that you can satisfy each and every
aspect of the essential criteria as specified in the Person Specification. Please use additional sheets if
necessary.

References
 Please supply details of two referees. These should not include relatives or purely personal friends. If
you are in current employment, one reference must be from your current employer. We will approach
your referees when a formal offer has been made and accepted

FIRST REFEREE SECOND REFERENCE

Name: Name:

Address: Address:

Tel: Tel:
Job Title: Job Title:
Email: Email:

Health
A disability or health problem will not preclude full consideration of your application.

How many days have you been absent from working owing to illness in the last 12 months ?__________

Do you have any recurring illnesses or disabilities? If yes, please give details:

Can you provide evidence of your eligibility to work on a permanent basis in the UK under the
requirements of s8 of the Asylum and Immigration Act 1996?

Yes  No 

Please note that in the event of being offered the post, you will be requested to provide such evidence.

Have you ever been convicted of a criminal offence? Yes  No 

If your answer is yes; please give details of date(s) of offence(s) and sentence(s) passed:

Convictions which are ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974 (as amended) need
not be disclosed.

DECLARATION
I certify that all particulars given are correct and understand that should any false statement(s)/
omission(s), be made on this form, PDS reserves the right of dismissal. I understand that employment
with PDS is subject to receipt of satisfactory references.

Signature Date
Please return this application form and any additional sheets to the postal or email
address
stated on the top of this form.