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					                                                           FOR OFFICE USE ONLY      VAC NO   APP NO




 Please complete this form in full in black ink (hand-written or typed) - C.V’s will not be accepted
and if included, will be removed from the form. If you have any queries, or require a special form,
              due to your disability, ring Human Resources on 01254 380117/380247

 Post applied for:                                        Vacancy No:

 Service Area:                                            Closing Date:


 DETAILS                 OF Please    give    details   of    work    you     have
 EMPLOYMENT                 undertaken.    This can include paid work, voluntary
                            work, or work at home. Start with the most recent
     Job Title          Employer               Dates Employed                       Reason for
                                                                                     leaving
                                             From                    To
                                        DD    MM     YY     DD       MM      YY




 PRESENT SALARY                    £                                    PER ANNUM
                                                        FOR OFFICE USE ONLY     VAC NO    APP NO




QUALIFICATIONS RELEVANT TO THE POST APPLIED FOR
(You will be asked to produce evidence of qualification before
employment commences).
Qualification obtained




ADDITIONAL DETAILS:

This section is very important. If you leave it blank, or do not put examples of how you meet
the criteria on the person specification, you will not be shortlisted for interview. We cannot
assume what you know, or what experience you have. For example, if we ask for experience of
dealing with people, you must show what experience you possess - it is not enough just to say
that you have ‘experience of dealing with people’. Shortlisting for this appointment will be
based upon an assessment of how applicants meet the criteria outlined in the person
specification.

Please include details of duties and responsibilities of your present and previous employment
that you feel are relevant and any information that you feel may be helpful to your application.
Please use this space to demonstrate how you meet the criteria. (Continue on additional A4
paper if necessary - please number the sheets but DO NOT PUT YOUR NAME ON THEM).
                                      FOR OFFICE USE ONLY   VAC NO   APP NO




ADDITIONAL DETAILS continued




ADDITIONAL TRAINING - include any relevant courses which you have
successfully taken

Details




MEMBERSHIP OF PROFESSIONAL BODIES - please provide details
                                              FOR OFFICE USE ONLY   VAC NO   APP NO




HEALTH/ MEDICAL REASONS

How many days’ sickness absence have you had in the last two years?


Please give dates, duration and reasons of absences:-




DO YOU HAVE A VALID DRIVING LICENCE?
                                                       FOR OFFICE USE ONLY    VAC NO    APP NO




                                   PERSONAL DETAILS

 Title                            Full Name
 Date of Birth
 Address for correspondence:




 Email
 Address
 Tel:                                         Tel: Mobile:
 Home:

 REFERENCES:         (Please give the name and address of two referees - one of these must be
 your present, or last, employer. Do not give the name of a member of the interviewing panel
 (if unsure, please ask). Your referees will be contacted unless you specifically request that
 they are not approached without your prior consent. We normally only contact referees after
 interview, but this is not always the case).

 Employer reference                              Personal reference




 Email                                           Email
 Tel No.                                         Tel No.
          Canvassing, either directly or indirectly, will disqualify your
                                  application.
 Are you related to any Councillor or employee of the Council?                     YES/NO
 If ‘Yes’, please give details.




 COMPLETED APPLICATION FORMS SHOULD BE POSTED OR EMAILED TO recruit@hyndburnbc.gov.uk
 OR HAND DELIVERED WITHIN OFFICE HOURS TO HYNDBURN BOROUGH COUNCIL, HUMAN
 RESOURCES, SCAITCLIFFE HOUSE, ORMEROD STREET, ACCRINGTON, LANCASHIRE. BB5 0PF
 PLEASE MARK THE ENVELOPE ‘ JOB APPLICATION - CONFIDENTIAL’.



I confirm that I am over 16 years old; I have disclosed any criminal record and pending
court action against me. I understand that, if appointed, I will be liable to disciplinary
action, including dismissal, should I knowingly give false information. I declare that the
information on this form is correct.


Signed:                                                           Dated:
                                                         FOR OFFICE USE ONLY       VAC NO     APP NO




           REHABILITATION OF OFFENDERS ACT 1974
   This Act allows an offender to be rehabilitated and his or her conviction becomes ‘spent’
   after the following periods of time:


                                                          Rehabilitation period
Sentence

                                               Age 18 or over                  Under 18 when
                                               when convicted                    convicted

Prison/detention in a young offender                  7 years                   3½ years or less
institution (YOI) for 6 months or less
Prison/detention in a YOI for more than 6             10 years                      5 years
months and up to 30 months
Most non-custodial sentences                          5 years                      2½ years
Absolute Discharge.                                  6 months                      6 months
Probation,     supervision,   care    order,   1 year or until order expires (whichever is longer)
conditional discharge or bind-over.
Attendance Centre Order.                                 1 year after the order expires
Hospital Order (with or without restriction       5 years , or 2 years after the order expires
order).                                                      (whichever is longer)


   If you have been sentenced for any offence and the above periods of time have not passed
   you must declare the offence. In this case, you must give full details of the offence, on
   the reverse of this form. If the period of time has passed you do not need to mention it on
   your application form, however, for certain posts within the authority, you will also be
   asked to complete a form which enables us to check whether or not you have any current
   convictions.

   Certain Posts are exempt from the Rehabilitation of Offenders Act 1974, including
   those involving work with children and/or vulnerable adults.           In these cases, all
   convictions, cautions, reprimands, final warnings and any other information should be
   disclosed. Only relevant information will be taken into account, so disclosure will not
   necessarily be a bar to obtaining the position. In additional, a Criminal Records Bureau
   (CRB) Disclosure will be requested for the successful applicant. The Council has written
   policy on the recruitment of ex-offenders, which will be made available on request.

   If you are not sure, please contact Human Resources, Scaitcliffe House, Ormerod
   Street, Accrington, by ringing (01254) 388111 for advice or information.

   I declare that I have disclosed any offences in line with the above statement.


   Signed: _________________________Date: ____________________
                                                           FOR OFFICE USE ONLY         VAC NO      APP NO




                                                                           HYNDBURN BOROUGH COUNCIL

                       Disability Questionnaire



Hyndburn Borough Council aims to provide equality of opportunity in employment and to
eliminate unlawful discrimination against disabled people. The Authority is committed to
meeting its obligations under the Disability Discrimination Act 1995.
Do you consider that you have a physical or mental impairment which has a substantial and
adverse effect on the ability to carry out normal day-to-day activities, and which has a long-
term effect? If so, and you fulfil all of the essential criteria of the post, to the satisfaction
of the shortlisting panel, then you will be guaranteed an interview.

                 I am not disabled:                  Please tick which is appropriate

                 I am disabled:

Please give details:

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    If you are not sure, please contact the Personnel Manager at Human
    Resources, Scaitcliffe House, Ormerod Street, Accrington by ringing
    (01254) 388111 for advice or information.
                                                                         FOR OFFICE USE ONLY          VAC NO       APP NO




                                  Employment Monitoring Form
                                                Strictly Confidential

Hyndburn Borough Council aims to provide equality of opportunity in employment. The Information
which is collated on this form is very important in helping us make sure our employment practices
are fair to everyone.

It is therefore the intention of the Council that no job application or employee shall be discriminated
against on the grounds of race, nationality, age, ethnic or national origin, gender, sexual
orientation, gender identification or disability. Selection criteria and procedures will be formulated
and frequently reviewed to ensure that individuals are selected, promoted and treated on the basis
of relevant merits and abilities.

We would, therefore, be grateful if you could complete this form, it does not form part of your
application, and will be removed prior to short listing. All information is treated in the strictest
confidence.


Your Racial origin:

0 – White                   British                       Irish                  Other

1 – Black or Black
                         Caribbean                       African                 Other
British
2 – Asian or Asian
                            Indian                      Pakistani              Kashmiri                  Bangladeshi
British
                                                         White/
                        White/Black                                             White/                     White/
3 – Mixed Race                                            Black
                        Caribbean                                               Indian                    Pakistani
                                                         African
4 - Chinese/ other
                           Chinese                       Other
group
5 – Prefer not to
answer

What are your Caring Responsibilities:

I look after                                      I help an adult with                             None
children                                          his/her daily routine

Your Gender:

                                                                                         Prefer not to
      Male                                      Female
                                                                                            answer

Gender Identity:         With regard to gender identity have you undergone, are you undergoing or do you plan to undergo a
permanent change of gender role/identity?

                                                                                         Prefer not to
       Yes                                         No
                                                                                            answer

Your disability status           (please read the definition on the disability form before answering this question
on Disability)
                                           I consider myself
   I am not a                                                                            Prefer not to
                                               a disabled
disabled person                                                                             answer
                                                 person
                                                           FOR OFFICE USE ONLY          VAC NO     APP NO




Your Age

 16- 19            20-29            30-39                    Prefer not to answer

 40 – 49           50-59             60+


Your Sexual Orientation

Heterosexual                      Bisexual                              Prefer not to
                                                                        answer
Gay Male                          Lesbian



Your Religion

Christian             Hindu                   Muslim                Sikh                  Jewish
                                                 No
Buddhist            Rastafarian              religious             Other
                                             affiliation
   Prefer not to
      answer

				
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posted:9/14/2012
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