Employment Application Form - page 1 Coquet Trust operates a No Smoking Policy Coquet Trust is an Equal Opportunities Employer. Our aim is to provide quality day and domiciliary care in the community for people with learning disabilities. All applicants who have a disability and meet the minimum criteria for the job will be interviewed. All your information will be treated confidentially. All fields marked with are required. Position Applied For:    Where did you see the post advertised?   PERSONAL DETAILS Surname:    First Name(s):    Date of birth:    Home: Work: Address:    Post Code:    Do you consider yourself to have a disability? Yes No If registered disabled please   give your registration number: Do you require a work permit? Yes No Do you hold a full driving licence for a car? Yes No Do you own a car? Yes No If yes would you be prepared to use your car at work? Yes No   CURRENT OR LAST EMPLOYMENT Employer’s name: Position held: Employer’s address: Date started: Date finished: Salary/wage: Other benefits: Brief description of duties, responsibilities etc:

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