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					Suffolk County Council                                                               SCC1

                                             JOB APPLICATION FORM

Please return completed applications to :             Bury St Edmunds County Upper School
                                                      Beetons Way
                                                      Bury St Edmunds
                                                      Suffolk IP32 6RF

          PLEASE READ THE ENCLOSED GUIDANCE NOTES BEFORE COMPLETING THIS FORM
                             Complete all shaded areas in black ink

Job title                                                                 Post Number
Department                                             Location

Personal Details

Surname                                                Date of birth
                                                       (This is only requested for
Title (Mr, Mrs, Ms)                                    administrative purposes)

Forenames                                              National Insurance No


Address                                                Home tel


                                                       Work tel


County                                    Postcode     E-mail address

Do you have a current driving licence?                                    Yes              No
(also see disability/health section below)

Please give licence details if the job entails driving public service or large goods vehicles

Give details of any penalties on your licence or convictions pending if driving is essential to the job




Do you have a disability / long term illness?                             Yes              No
(also see disability/health section below)

If “yes”, indicate here if you are aware of any adjustments that the County Council could make to help
you apply for or carry out the job (see guidance notes)


                                                                      Continue on separate sheet if required

Are you applying to do this job on a job-sharing basis?                   Yes              No

If “yes”, indicate here if you wish your application to be considered as a joint application with
Someone else, giving his / her name



Working towards equality of opportunity                                                    Page   1 of 6
                                    Educational qualifications and training
                           You may be asked to provide evidence of qualifications obtained

Secondary education (CSE, GCE, GCSE, A Levels etc)
 Examination              Level                    Subject(s)                      Grade        Date of exam




FURTHER AND HIGHER EDUCATION (Degree, Diploma, BTEC, City & Guilds, NVQ etc)
     Institution     Dates   Full   Qualification            Subject                                 Pass Level
                            or PT                                                                     or Grade




Other relevant qualifications including membership of professional bodies




Relevant training and personal development (State who provided training, duration and dates)
Examples could include: short courses, skills training, external awards/activities, etc.




                                                                         Continue on separate sheet if required

Working towards equality of opportunity                                                       Page   2 of 6
                                          Current / latest employment

Name and address of current / most recent               Job title
employer
                                                        Current / latest salary and any benefits

                                                        Weekly hours

Date started in post                                    Date of leaving (if relevant)
Notice required                                         Reason for leaving



Main duties / responsibilities / achievements




References

Normally, references will be requested for all candidates invited for interview, unless you ask us not to by
ticking the “no” boxes below. This will not affect our decision to invite you for interview. However, references
will need to be taken up at some stage if you are successful. The County Council operates a policy of open
references. This means that the person who is the subject of a reference may read it, upon request.

Please give the names and addresses of who people who would be willing to supply a reference about you,
including your most recent employer (or teacher / tutor, where appropriate), who have known you during the
past three years, if that is possible. Please also state in what capacity they know you.

Name                                                         Name

Address                                                      Address




Tel no                                                       Tel no

E-mail address                                               E-mail address
Relationship                                                 Relationship

Organisation (if applicable)                                 Organisation (if applicable)

May we contact them if we decide to invite you for interview?
Yes                    No                                    Yes                No

Working towards equality of opportunity                                                       Page   3 of 6
             The information requested on this page may be provided on a separate sheet if preferred

                                          Work and other relevant experience

Please list below a complete record of other employments and activities, either paid or unpaid. These should
be in date order, starting with the most recent.

     Dates
                     Name of organisation and         Job title / role with brief indication of      Reason for
From        To
                     nature of business               main duties and responsibilities               leaving
 mm         mm
 yy         yy




                                                                      Continue on separate sheet     if required

Working towards equality of opportunity                                                            Page   4 of 6
             The information requested on this page may be provided on a separate sheet if preferred

                                          How you meet the selection criteria

It is important that you provide evidence in this section of how you meet the criteria set out in the details
provided. Tell us about things you were responsible for and what you achieved. Include examples from paid
or unpaid work or other activities you have undertaken that are relevant to the job you are applying for. Also
include here information about why you want the job and anything else you wish to say.




                                                                          Continue on separate sheet if required

Working towards equality of opportunity                                                        Page   5 of 6
                                          You must complete all sections on this page

Canvassing of county councillors, school governors or senior employees
Canvassing of county councillors, school governors or employees of the County Council, by or on behalf of
yourself, is strictly forbidden and may invalidate your application.
Indicate here if you are related to any county councillor, school governor or senior employee of the
County Council, giving their name (and department, if known, where relevant).
Please state NONE if appropriate.




Criminal convictions
Please give details of criminal convictions below. Unless stated otherwise, you do not need to declare
convictions which are “spent”, as defined by the Rehabilitation of Offenders Act 1974 and subsequent
regulations.
However, if you are applying for a job supervising, caring for or otherwise connected with people from the
following list, you must always declare any convictions and/or cautions for criminal offences, even where
they are “spent”. For these purposes, this includes working with children, young and older people, those who
are dependent on alcohol or drugs, and those with mental or physical disabilities, illness, injury or deformity,
including people who are blind, deaf or without speech.
For certain posts, police checks will be required. If this is necessary, you will be asked to sign a separate
authorisation.
Details of criminal convictions Please state NONE if appropriate.




Entitlement to work in the UK
To comply with the Asylum and Immigration Act 1996 all prospective employees will be asked to supply
evidence of eligibility to work in the UK. We will ask to see an appropriate official document (for example, a
document showing your national insurance number, if you have one, your birth certificate, passport etc). Do
not send these now. Further information will be sent to you if you are selected.
Do you require a work permit to work in the UK?                                         Yes         No

If you already have a work permit, please give the expiry date


Declaration
To the best of my knowledge, the information I have supplied on this form is correct. I understand that giving
false information or omitting relevant information could disqualify my application and, if I am appointed, could
lead to me dismissal.


Signed                                                                       Date

FOR OFFICE USE ONLY
                 Give details below of reasons for non-selection related to details provided
Selection stage   QUALIFICATIONS         KNOWLEDGE               SKILLS                OTHER
Invited for interview
Yes           No

Offered job
Yes         No

Please indicate if:          appointed               withdrew              other



                        Signed by Manager ……………………………………………….                                 Date ………………………
Working towards equality of opportunity                                                             Page 6 of 6
                                              GUIDANCE NOTES

Completing the application form
   In addition to these Guidance Notes, please read carefully the notes you will find at the various
    sections on the application form.
   If you would like the application form in another format because of a disability (e.g. Braille, large
    print or floppy disk) please contact the department that supplied you with this application form.
   We will accept applications in other formats, e.g. audio tape, where an applicant has difficulty in completing
    the form because of a disability or learning difficulty.
   Read the job description and any other documentation you have been sent before completing the form.
    Tailor your responses to the job for which you are applying.
   We will use the information you supply to assess how well you meet the selection criteria, as set down in the
    details provided. Make sure you include evidence relating to as many of the aspects of the post as possible.
   Include experience and achievements from any sphere of your life. You could include evidence of
    knowledge and skills gained through voluntary work, involvement in community activities, managing a home
    and family, school / college and special interests as well as previous paid employment. Tell us about any
    unpaid work you do or any position of responsibility you hold, for example in a club, or organisation you
    belong to.
   Complete all the shaded sections where questions are posed. You may complete the form by hand (in
    black ink please to assist photocopying) or by typing your responses. Include extra sheets if there isn’t
    enough room in the boxes provided.
   If you would like us to acknowledge receipt of your application form, please enclose a stamped,
    addressed envelope marked “A” in the top left-hand corner. If you wish to be informed once the
    post has been filled, please enclose a second stamped, addressed envelope.

Equal opportunities policy
“Suffolk County Council confirms that its employment policy aims to offer full equality of opportunity. Employees
and prospective employees will not be unfairly discriminated against on grounds of their sex, marital status,
colour, race, nationality, ethnic or national origin, religion, disability, sexual orientation, age, trade union
membership or non-membership. Where an employee may be disadvantaged on these grounds, the County
Council will make every reasonable effort to rectify such disadvantage(s). Employment terms and conditions
and decisions on recruitment, selection, training, promotion and dismissal will be made solely on the basis of
objective criteria.”
A separate leaflet called “Working towards equality of opportunity” explains the County Council’s flexible working
arrangements, age (discrimination) policy, policy on employing disabled people and monitoring arrangements. If
you have not had a copy and would like one, please ask.

Job Sharing
It is County Council policy to consider applications for job sharing for all full-time posts unless this is not
practicable in the particular circumstances that apply. You do not need a job share partner in order to apply to
job share.

Disability / health
If you have indicated that you have a disability or a long-term medical condition and provide evidence that you
meet all the essential criteria for the post (with any reasonable adjustments), you will be offered an interview as
part of the County Council’s commitment to the employment of disabled people.
Please tell us about any adjustments that would help you apply for this post or carry out the job, if successful.
For example, where the job entails visiting different parts of the county, tell us if you are unable to drive because
of a disability. Please also tell us if you would have difficulty lifting heavy objects where the job could require
this. The County Council may be able to make alternative arrangements. We may also be able to provide sign
language interpreters, time off for treatment, rest breaks during the day, special equipment, workplace
adaptations, etc.
All employees are required to complete either a health / disability declaration or a medical questionnaire,
depending on the nature of the work. Some employees, especially those who handle food or who work with
vulnerable groups such as children or the elderly, may also be required to provide specimens and/or attend a
medical examination.

Working towards equality of opportunity
          Suffolk County Council Education



STATEMENT OF POLICY ABOUT RELEVANT CONVICTIONS


The Job for which you are applying involves substantial opportunity for access to
children. It is therefore exempt from the Rehabilitation of Offenders Act, 1974. You
are therefore required to declare any convictions or cautions you may have, even if
they would not otherwise be regarded as “spent” under this Act. This information
you give will be treated in confidence and will only be taken into account in relation
to an application where the exemption applies. The Council is also entitled, under
arrangements introduced for the protection of children, to check with the police for
the existence and content of any criminal record of the successful applicant.
Information received from the police will be kept in strict confidence and wil be
destroyed immediately the selection process is completed. The disclosure of a
criminal record will not debar you from appointment unless the selection panel
considers that the conviction renders you unsuitable for appointment. In making
this decision the panel will consider the nature of the offence, how long ago and
what age you were when it was committed and any other factors which may be
relevant, including appropriate considerations in relation to the Council’s published
Equal Opportunities Policy.


Failure to declare a conviction may, however, disqualify you from appointment, or
result in summary dismissal if the discrepancy comes to light.


If you would like to have further advice or to discuss, in confidence, whether a
conviction you have would debar you from working with children you may
telephone Jenny Wagstaff/Jan Pettifer, Area Personnel Officers, on direct dial
(01502) 405213.

				
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