request to appoint dec11 by yv0Yk7n

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									                                         REQUEST TO APPOINT FORM

                                          CHECKLIST FOR RECRUITERS




     Please send back the following documentation with your Request for Appointment of Staff Form:-

     Application Form (Support Staff)

     Curriculum Vitaé and Applicant information Form (Academic and Related Staff)

     Short-listing matrix

     GIS Form

     Copy of front cover and personal details page and any relevant Visa stamps confirming right
     to work in the UK

     Please note that in order for appointments to be processed by HR an FSL must have been produced pre-
     appointment and sent to the HR Systems team.

     Additional information required for ‘Certificate of Sponsorship Appointments’:

     Certificate of Sponsorship Request Form, available at www.liv.ac.uk/hr/Work_Permits/Index

     Photocopy of the front cover and personal details page of the appointee’s passport and
     their most recent UK Visa stamp (if applicable) signed and dated by the Recruiter ‘as seen’.

     Photocopy of academic qualifications and/or professional accreditations signed and dated
     by the Recruiter ‘as seen’.

     Evidence of English Language skills (see Certificate of Sponsorship Guidance for Recruiters
     www.liv.ac.uk./hr/Work_Permits/index for further information).

     Statement detailing selection process and reasons for appointing the candidate.

     Evidence of funding where this comes from outside the University eg grant award letter.

     List of applicants and reasons for non-selection.

      PLEASE NOTE THAT THE APPONTMENT MAY BE DELAYEDWE CANNOT MAKE AN APPOINTMENT UNTIL
                    WE HAVE RECEIVED ALL THE RELEVANT DOCUMENTATION AS ABOVE

                                               DATA PROTECTION

The personal data contained in this form will be used for processes connected with the administration of your
employment, health, welfare and safety including any other legitimate statutory or regulatory purpose.




                                                                                                   Page 1 of 6
                                         REQUEST FOR APPOINTMENT OF STAFF

This form should be completed once the Selection Committee has agreed to recommend the appointment of the
successful candidate. Please return this form with the application form, CV, references and passport copy or other
immigration information (if appropriate) signed ‘as seen’ by a member of the recruitment panel for the successful
candidate to Human Resources, Hart Building, Mount Pleasant, Liverpool, L3 5QT.

                                            SELECTION COMMITTEE REPORT

Selection Committee Membership (please list):




                                                       POST DETAILS

Department/School:

Post Title:

Advertised in:

Post/Advert Ref No:

Grant Code:

If the post was not advertised, please state reason:




                                                APPLICANTS’ DETAILS

No. of Applicants:                         No. Shortlisted:                   No. Interviewed:


                                      RECOMMENDATION FOR APPOINTMENT

Title of Successful Applicant:                                D.O.B:
Forename(s):
Surname:
Salary:                                    Salary Range:                       Grade:
Starting Date:                                     End of tenure (if applicable):


                                                                                             Page 2 of 6
Probationary Appointment (for academic staff only)?           Yes        No


If so, please give dates of probation:          From:                          To:    30 September (enter year)


(a) Hours (e.g. ft/pt/UTTO/STTO)                         (b) No. of Hours (if p/t)
If term time please indicate
number of weeks per year:
Medical Required:                        Yes            No           (Please     the appropriate box)
Certificate of Sponsorship required:     Yes            No           (Please     the appropriate box)


                    IF YES, PLEASE COMPLETE CERTIFICATE OF SPONSORSHIP REQUEST FORM

If the appointee is not U.K. or EC national and a certificate of sponsorship is not required, please enclose documentary
evidence of this.


                                               REASONS FOR APPOINTMENT

Please state the reasons why the Selection Committee is recommending the appointment of the candidate named
above:




                                 PRE EXPOSURE MEDICAL CHECKS - Hazards/Allergens

If this role will be exposed to any hazards or allergens, it may be subject to a health screening by the Occupational
Health Department and/or a risk assessment by the University Safety Adviser’s Office. You should notify the Safety
Adviser’s Office if any exposure is likely to occur. See Appendix A for guidance on each of the categories below
before indicating exposure to any hazards/allergens.

If you have already informed Occupational Health/Safety Adviser’s Office, please      the appropriate box below:

 OCCUPATIONAL HEALTH DEPARTMENT
 SAFETY ADVISER’S OFFICE
 INDIVIDUAL NOT EXPOSED TO ANY
 HAZARDS OR ALLERGENS

Please ensure that the following sections are completed as appropriate, indicating if the post-holder will be:

 REQUIRED TO UNDERTAKE:                                                                             Please    the
                                                                                                    appropriate
                                                                                                    box
 Manual Handling
 Food Handling/Food Preparation


                                                                                               Page 3 of 6
 Work involving any Hazard Group 3 Biological Agents or specimens likely to contain them (see
 Appendix A for further detail)
 Work involving handling Pathogens or potentially infected specimens of Unfixed Human Tissue
 (Including Blood)
 BE EXPOSED TO:

 Animals
 Gluteraldehyde
 Any other asthmagen
 Loud noise
 Vibration (working with hand-held vibrating equipment)


PLEASE SPECIFY DETAILS IF WORK INVOLVES HANDLING PATHOGENS OR POTENTIALLY INFECTED SPECIMENS OF
UNFIXED HUMAN TISSUE FROM LIST CONTAINED IN APPENDIX A:

                                            CRIMINAL RECORDS BUREAU

Will the post holder be working with young people (under 18) and/or vulnerable adults?
      Yes            No           (Please   the appropriate box)
Please specify details:


              A copy of the policy on the Recruitment and Employment of Ex-offenders is available at:
                          http://www.liv.ac.uk/hr/recruitment/documents/Ex-Offenders.pdf


                                  MEDICAL, DENTAL AND VETERINARY FACULTIES ONLY:

Honorary Clinical Contract Required:        Yes          No         (Please    the appropriate box)
Type of Contract           01 Consultant                              To be issued by:
(if applicable)
                           04 Associate Specialist
                           05 General Practitioner
                           08 Foundation Programme
                           Doctor
                           09 Specialty Registrar
                           10 Specialty Doctor
                           11 Non-Medical Grade
General Medical Council No. (GMC) (if applicable)
General Dental Council No. (GDC) (if applicable)
Pleased indicate if appointee is registered with the Health Professions Council or the Nursing and Midwifery
Council:

                                                                                             Page 4 of 6
Health Professions Council               Yes         No      (Please     the appropriate box)
Nursing ;and Midwifery Council           Yes         No      (Please     the appropriate box)
Please indicate if appointee is a member of the Royal College of Veterinary Surgeons Council (MRVCS) (if
applicable)
     Yes            No             (Please      the appropriate box)


Special conditions (if any):


                                                NHS RESEARCH PASSPORT

Will the postholder hold an honorary NHS research passport?

Please note that if the post-holder will be involved in contact with patients they may require a Research Passport.
Recruiters should review guidance on the Research Passport criteria and process which are available at
http://www.liv.ac.uk/hr/Undertaking_Research_in_NHS/index.htm in order to make this assessment.

       Yes        No           (Please       the appropriate box)
Please specify details



  SUMMARY OF CURRICULUM VITAE FOR SUCCESSFUL CANDIDATE (For Academic staff and Senior Library staff)

Address:

Qualifications:

Brief Summary of CV:-




                                                     MANUAL STAFF ONLY


Please indicate whether this is:             an appointment for a member of staff new to the
                                             University
                                             an additional appointment for an existing member of
                                             staff
                                             a change of hours
                                             a transfer
Please indicate whether this appointment is:
Permanent                                    Fixed-Term                         Casual
All Year Round                               Term-Time                 Weeks    Hours per week

                                                                                                   Page 5 of 6
Medical Required Yes               No         (Please      the appropriate box)
Medical arranged for (date)
On first day to report to:                          at (building)                              (time)
(name)



                       WEEK ONE OR TERM TIME HOURS                    WEEK TWO OR VACATION HOURS

                                          Time                                        Time
                        Start Time                       Hours        Start Time                         Hours
                                        Finished                                    Finished
                                                        Payable                                         Payable
 MONDAY
 TUESDAY
 WEDNESDAY
 THURSDAY
 FRIDAY
 SATURDAY
 SUNDAY
 HOURS:   Single             1.1        1.3        1.5            D           S/S       A/S             TOTAL


 Additional Comments:




                                                 FOR OFFICE USE ONLY
                                               APPOINTMENT APPROVAL

Head of Department Signature:-

Executive Pro Vice Chancellor’s
Signature(All Academic and Senior
Library staff):-


Date:




                                                                                                 Page 6 of 6
APPENDIX A

                            PRE EXPOSURE MEDICAL CHECKS - HAZARDS/ALLERGENS
                                       GUIDANCE FOR RECRUITERS

If a role at the University will be exposed to any hazards or allergens, it may be subject to a medical assessment by
Occupational Health and/or a risk assessment by the University Safety Adviser’s Office. You should notify the
University Safety Adviser’s Office if any such exposure is likely to occur.
In addition to this document, further information regarding exposure to hazards or allergens is available at:
www.liv.ac.uk/intranet/safety/safety circulars/a-z.htm.

GENERAL INFORMATION

MANUAL HANDING

This box should be ticked if a member of staff will be undertaking manual handling as part of their role.
Further information on manual handling can be found at:
http://www.liv.ac.uk/safety/safety_issues/Manual_handling.htm

FOOD HANDLING/FOOD PREPARATION

This box should be ticked if a member of staff will be undertaking food handling/preparation as part of their role.


WHERE A ROLE AT THE UNIVERSITY REQUIRES EITHER OF THE ABOVE, THE APPOINTEE WILL BE REQUIRED TO
ATTEND A HEALTH SCREENING AT THE OCCUPATIONAL HEALTH DEPARTMENT, WHICH WILL BE MADE CLEAR
IN THE FURTHER PARTICULARS FOR THE POST.
ON BEING OFFERED THE POSITION, A DATE AND TIME FOR THE SCREENING WILL BE ARRANGED BY THE HR
DEPARTMENT IN CONSULTATION WITH OCCUPATIONAL HEALTH. INDIVIDUALS WILL BE INFORMED OF
THEIR APPOINTMENT DATE AND TIME IN THEIR OFFER LETTER.


WORK INVOVING ANY HAZARD GROUP 3 BIOLOGICAL AGENTS OR SPECIMENS LIKELY TO CONTAIN THEM

This box should be ticked if a member of staff will be working work with any hazard group 3 biological agents
(micro-organisms) or specimens likely to contain them. Examples of hazard group 3 biological agents are:

Bacillus anthracis, Brucella abortus, Mycobacterium tuberculosis, Salmonella typhi, Japanese encephalitis virus,
Hepatitis B virus, monkeypox virus, human immunodeficiency viruses, Plasmodium falciparum, Trypanosome
brucei rhodesiense, Coccidioides immitis, Penicillium marneffei. A full list is available at:
http://www.hse.gov.uk/pubns/misc208.pdf

Recruiters should note that the above list is not exhaustive and are advised to contact Lesley Andrews, Biological
Safety Adviser, email: l.andrews@liv.ac.uk for advice before ticking this box.

WHERE A ROLE INVOLVES EXPOSURE TO THE ABOVE, HR WILL NOTIFY THE SAFETY ADVISER’S OFFICE

 WORK INVOLVING HANDLING PATHOGENS OR POTENTIALLY INFECTED SPECIMENS OF UNFIXED HUMAN
 TISSUE (INCLUDING BLOOD)

This box should be ticked if a member of staff will be undertaking work with any pathogens against which there
is an effective immunisation? Examples of such pathogens include the Measles virus, Rubella virus, Hepatitis B
                                                                                                       Page 1 of 3
virus and Tuberculosis. A list is available at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079917

The more information you can provide at t his stage will be helpful in determining whether there is a
vaccination for the pathogen the individual is working with.

WHERE A ROLE AT THE UNIVERSITY REQUIRES THE ABOVE, THE APPOINTEE WILL BE ADVISED IN THEIR OFFER
OF APPOINTMENT LETTER TO CONTACT THE OCCUPATIONAL HEALTH DEPARTMENT TO CHECK ON THEIR
VACCINATION STATUS.


 EXPOSURE TO ANIMALS, GLUTARALDEHYDE OR ANY OTHER ASTHMAGEN

 These boxes should be only be ticked if a member of staff will be undertaking work involving exposure to animals
 (exposure requiring health screening is defined as anyone who enters a room containing a whole animal (alive or
 dead)
 at least once a month; this includes those entering for only short periods of time), glutaraldehyde or any other
 asthmagen as part of their role. Further information on exposure to animals is available as indicated below:

 Code of Practice on controlling exposure to laboratory animal allergens:

 http://www.liv.ac.uk/safety/documents_guidance/Codes%20of%20Practice/COP_on_Allergy_to_animals_June_
 2008_revision.pdf

 General information on asthmagens:

 http://www.liv.ac.uk/safety/Hazard_A_to_Z/Respiratory_Sensitisers.htm


WHERE A ROLE AT THE UNIVERSITY REQUIRES THE ABOVE, THE APPOINTEE WILL BE REQUIRED TO COMPLETE
A HEALTH SCREENING QUESTIONNAIRE AND CLEARANCE FROM OCCUPATIONAL HEALTH MUST BE RECEIVED
BEFORE EXPOSURE, WHICH WILL BE MADE CLEAR IN THE FURTHER PARTICULARS FOR THE POST.
APPOINTEES IN THIS CATEGORY WILL BE CONTACTED DIRECTLY BY OCCUPATIONAL HEALTH IN ADVANCE OF
THEIR START DATE AT THE UNIVERSITY.

EXPOSURE TO LOUD NOISE

This box should only be ticked if a member of staff will be exposed to loud noise as part of their role
above 85dB(A) and a peak of 137dB(C) as indicated on the Health & Safety website. Detailed information around
noise
levels can be found at: www.liv.ac.uk/safety/Hazard_A_to_Z/Noise. Recruiters are advised to read this
information in
detail before ticking this box. A quantitative risk assessment documenting the likely exposure level is essential and
must
be supplied to Occupational Health. Please note that it is possible that new staff employed to work in the
following areas
may be exposed to high levels of noise:

Engineering workshops: Facilities Management (woodworking workshops, gardeners, energy plant); Small
Animal Hospital (kennels); Student Guild (entertainment staff); Carnatic House (catering assistants, kitchen
porters); Wyncote (groundsmen); Woodpark Farm (farmhands); Ness Heath Farm (farmhands); Ness Botanic
Gardens (gardeners).




                                                                                                        Page 2 of 3
EXPOSURE TO VIBRATION

This box should be ticked only if a member of staff will be exposed to high levels of hand/arm vibration where a
formal risk assessment by the University Safety Adviser is required. A formal risk assessment is required if
vibration levels are > 2.5 msˉ² A(8). It is possible that new staff employed to work in the following areas may be
exposed to high levels of hand/arm vibration:

Facilities Management (woodworking workshops); Wyncote (groundsmen); Ness Botanic Gardens (gardeners).

Detailed information on vibration can be found at: www.liv.ac.uk/safety/Hazard_A_to_Z/Vibration

WHERE A ROLE AT THE UNIVERSITY REQUIRES EITHER (NOISE OR VIBRATION) OF THE ABOVE, THE APPOINTEE
WILL BE REQUIRED TO ATTEND HEALTH SCREENING AT THE OCCUPATIONAL HEALTH DEPARTMENT AND
CLEARANCE FROM OCCUPATIONAL HEALTH MUST BE RECEIVED BEFORE EXPOSURE, WHICH WILL BE MADE
CLEAR IN THE FURTHER PARTICULARS FOR THE POST.
ON BEING OFFERED THE POSITION, A DATE AND TIME FOR THE SCREENING WILL BE ARRANGED BY THE HR
DEPARTMENT IN CONSULTATION WITH OCCUPATIONAL HEALTH. INDIVIDUALS WILL BE INFORMED OF THEIR
APPOINTMENT DATE AND TIME IN THEIR OFFER LETTER.
IN ADDITION, WHERE EITHER OF THE ABOVE HAS BEEN TICKED, HR WILL LIAISE WITH THE SAFETY ADVISER’S
OFFICE TO ENSURE A RISK ASSESSMENT IS COMPLETED.




Dec 2011




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