Application Form

Please complete this form and send it to: 	Skillshare International	
	126 New Walk 	
	Leicester 	
	LE1 7JA, UK	
		
Or as an email attachment to:  	recruitment@skillshare.org	

1. About the post applied for 	
Post applied for (General recruitment/Specific: Code)		
Have you received a job description? (yes/no)		
If you are applying for a specific position, please tailor your application to the job description and the person specification. 	

2. Personal details	
Please note that you may NOT apply for a placement in your home country. 	
Title (Mr / Mrs / Miss / Ms / Dr)		
Full Name		
Street		
Postal Code		
Town		
Country		
Email Address		
Tel Home		
Tel Work		
Mobile Number		
Citizenship		
Please tell us your current occupation/profession		
2 years relevant work experience (yes/no)		
National Insurance Number (if applicable):		
Do you hold a current driving licence (yes/no)		
Country of issue		
Have you ever been convicted of a criminal offence? (yes/no)		
Do you have any criminal proceedings pending?		
Development Workers working with Skillshare International should generally be aged between 21-62 years old. Please indicate if this is the case. (yes/no)		

3. Educational background	
Please tick applicable box. 	
Service delivery/Business (Finance, project management, small business, IT support) 		
Health and Care (Primary health care, community health trainers, occupational therapists, physiotherapists, doctors, nurses, public health)		
Agriculture (forestry, …)		
Media and Communication		
Education/Social work (TEFL, Technical/Vocational, Curriculum Development, IT Trainers, Primary Teachers)		
Management		
Administration		
Environment (renewable energy, eco tourism, …)		
Technical (architects, civil engineers, surveyors, …)		
Unemployed		
Law, Advocacy, Campaigning		
Fundraising		
Others, please specify: 		

4. Availability 	
Between the moment you submit your application until you can take up the placement, it can last 3-6 months	
For how long would you be able to commit to a DW placement? 		
Please tell us on which dates you are NOT available for interview		
When would you be able to take up a position? (month/year)		

5. Relationships	
Please tick	since	
Single			
With a partner			
Engaged			
Married			
Divorced			
Separated			
Widowed			

6. Couples/Partners	
Please note: 
If you are both applying to go overseas as development workers, please
•	complete an application form each
•	note that it may not be easy to place you both in the same area. 
•	Note that flights and medical cover may be provided for partners who are not development workers. 	
Is your partner applying to become a development worker? (yes/no)		
If not, would you intend to live together during your placement? (yes/no)		
What is the name of your partner? 		
Is your partner between 21 and 62 years old?		

7. Children/dependants	
Please note:
In certain circumstances Skillshare International is able to recruit people with children (under 18). In which case, Skillshare International will provide flights and medical cover. You should think carefully before taking your decision. Living conditions and the education system might be very different.	
Do you have any dependant children (yes/no)		
If yes, please state name, age and sex?		
Would any of them accompany you? (yes/no), (name)	

8. Financial commitments	
Please think carefully about the financial implications of working as a development worker. You will be paid a monthly allowance which is enough for a reasonable standard of living, but not enough to provide for savings etc. 	
Do you have any financial obligations, eg life insurance, mortgage, maintenance etc. yes/no		
How much do you have to pay each month on average? (in £)		
How will you meet these financial obligations?		

9. About your education and training	
Please tell us about any education and training that you have had since leaving school. Please do not use abbreviations. Please copy and paste as many boxes as you need. 	

Institution 
(name and address):		
Type of education or training 
(e.g. apprenticeship, degree, etc.)		
Date: from (month/year) to		
Degree(s) or Diploma(s) obtained:		
Full time / Part time		

Institution 
(name and address):		
Type of education or training 
(e.g. apprenticeship, degree, etc.)		
Date: from (month/year) to		
Degree(s) or Diploma(s) obtained:		
Full time / Part time		

10. Your work experience (including current position)	
Please give brief details of your work experience starting with your most recent job. Please list your duties and responsibilities in each job, especially where you have trained and supervised others. Please do not use abbreviations. If you are applying for a specific post, please point out relevant skills, knowledge, qualifications and experiences for it with regard to the essential and desirable criteria in the person’s specification. 
Please copy and paste as many boxes as you need.	

Institution/Company 
(name and address):		
Date: from (month/year) to		
Position (Job title):		
Description of duties 
and responsibilities		

Institution/Company 
(name and address):		
Date: from (month/year) to		
Position (Job title):		
Description of duties 
and responsibilities		

Institution/Company 
(name and address):		
Date: from (month/year) to		
Position (Job title):		
Description of duties 
and responsibilities		

Institution/Company 
(name and address):		
Date: from (month/year) to		
Position (Job title):		
Description of duties 
and responsibilities		

Institution/Company 
(name and address):		
Date: from (month/year) to		
Position (Job title):		
Description of duties 
and responsibilities		

11. Other skills:	
Computer skills 	
If computer literate please mention which programmes you are familiar with: 	
	
Language skills: 	
Mark 1 to 5 for competence, where 5 is the highest	
Language	Reading	Speaking	Writing	
(mother tongue)	5	5	5	

				
Interests and other skills	
Please give brief details of your spare time activities, interests, (eg craft skills, sports, travel, etc) and additional skills gained outside professional work. Include any voluntary work you have done, if any.	

12. Information in support of your application	
If you are applying for a specific job, please tell us briefly what interests you about the job. 	
	
Why do you want to work in a developing country as a development worker?	
	
Please describe your experiences of working or living in a different culture:	

13. About your health	
You will need to have a full medical examination, normally given by your own GP, before you are finally accepted as a development worker/health trainer, but please answer these questions now. If you answer yes to any of the following questions please give brief details in the space provided. 	
Have you ever had any serious physical or mental illness, operation or accident? (yes/no)		Details:	
Are you taking any type of medication? (yes/no)		Details:	
Have you ever received any medical or psychiatric treatment? (yes/no)		Details:	
Do you have any objection to vaccinations? (yes/no)		Details	

Your doctor’s name and address:
Our medical advisor may need to contact your doctor for more information in an emergency: 	
Please indicate that we may do so. (yes/no)		
Name:		
Address:		
Country:
Postal Code: 		
Practice Telephone: 		

14. About your references	
References are taken up before interview. Please give the names and addresses of three people who will act as referees. Please give people who can be contacted easily. 
They must not be related to you. At least one of your references must be an employer, tutor or client if self-employed. 	

Professional reference
Title: (Mr / Mrs / Miss / Ms / Dr)		
Name:		
Address:		
Country:
Postal Code: 		
Home Tel: 		
Work Tel: 		
Mobile: 		
Email:  		
Occupation: 		
How do they know you: 		
Can we contact them now: (yes/no)		

Personal reference
Title: (Mr / Mrs / Miss / Ms / Dr)		
Name:		
Address:		
Country:
Postal Code: 		
Home Tel: 		
Work Tel: 		
Mobile: 		
Email:  		
Occupation: 		
How do they know you: 		
Can we contact them now: (yes/no)		

Other (either personal or professional)
Title: (Mr / Mrs / Miss / Ms / Dr)		
Name:		
Address:		
Country:
Postal Code: 		
Home Tel: 		
Work Tel: 		
Mobile: 		
Email:  		
Occupation: 		
How do they know you: 		
Can we contact them now: (yes/no)		

15. How did you hear about Skillshare International: 	
Please tick	
Recruitment event		
Ex–development worker		
Internet, please specify the website: ………………………………………………..		
VSO/ICD (CIIR)/Progressio		
Newspaper article		
Newspaper advert		
Poster		
Radio or TV		
Exhibition		
Recruitment talk		
Other: 		

16. Information for Criminal record Disclosure	
Skillshare International is required to request a criminal record Disclosure for every development worker. For the purpose of directing you to the most appropriate police check, please indicate in which countries you have been living during the last 10 years.	
Date (from month/year to month/year)	Country	

		

17. Declaration: 	
Development Workers applying for work that will them bring into contact with children as part of their duties may be required to disclose convictions which may be considered spent under the rehabilitation of offenders Act 1975. In these circumstances Skillshare International reserves the right to make checks as to previous convictions. A criminal record will not necessarily be a bar to obtaining a position. 	
The information you give on this application form should be held by Skillshare International. In order to assess your suitability for a particular position, it may be necessary to transfer the information you give on this form to Skillshare International offices abroad. Signing the application form you are giving consent to this. 	
The work of Skillshare International is based on a Code of conduct. All future staff members and development workers of Skillshare International will be asked to sign it. 	

I have read and understood this form. The information I have given is correct to the best of my knowledge. 

Signature: 

Date: