HEATH FARM SCHOOL

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					                                     HEATH FARM SCHOOL

                           APPLICATION FORM FOR EMPLOYMENT


Heath Farm School is committed to developing and implementing its Equal Opportunities
                               Policies and Practices


The information given by you on this form will be the basis upon which the decision is made
whether or not to invite you for interview. Please complete in black ink for photocopying
purposes.


1.     Vacancy Details

        Post for which you are applying:

        School / Department:

        Post Number / Reference Number:

        Type of role*:   Full Time      Part Time     Other, please state….............................................

        *Please delete as appropriate


2.     Personal Details

        Surname:                                                Forename(s):

        Title:

        Address:




        Post Code:                                              Telephone: Day:
                                                                             Evening:
                                                                (Please include STD codes)

        DfEE Ref. No.

        Do you have a full current Driving Licence?             YES / NO*
        *Please delete as appropriate


3.     Present Employment (If you are currently unemployed please leave blank)

        Employer’s Name:

        Address:                                                Post / Job Title:

                                                                Basic Wage / Salary / Grade:

                                                                Other Pay:

        Postcode:                                               Date Commenced:

        Telephone Number:                                       Period of Notice:
        (Please include STD codes)
4.   Education

                                                                     Qualification &
                 Date         School / College /      Subject       Grade obtained /
                                 University                          being sought




5.   Training


                 Date            Course Title         Organiser          Length




6.   Membership of Professional Bodies


                 Date             Professional Body        Number      Grade / Status
7.   Previous Employment

     Please list below all previous employers and positions held starting with most recent first


      Post Title:

      Employer’s Name:

      Address:                                             Date Started:

                                                           Date Left:

      Postcode:

      Telephone Number:
      (Please include STD codes)

      Outline of Duties:




      Reason for Leaving:


      Post Title:

      Employer’s Name:

      Address:                                             Date Started:

                                                           Date Left:

      Postcode:

      Telephone Number:
      (Please include STD codes)

      Outline of Duties:




      Reason for Leaving:


      Post Title:

      Employer’s Name:

      Address:                                             Date Started:

                                                           Date Left:

      Postcode:

      Telephone Number:
      (Please include STD codes)

      Outline of Duties:




      Reason for Leaving:
 Post Title:

 Employer’s Name:

 Address:                                     Date Started:

                                              Date Left:

 Postcode:

 Telephone Number:
 (Please include STD codes)

 Outline of Duties:




 Reason for Leaving:


If necessary please continue on a separate sheet(s) of A4 paper, placing your name in
the TOP RIGHT corner and numbering the additional sheets.
8.   Further Details


      Please give any information that you think will help us to consider your application further.
      Include the reasons why you are applying for this post, further details of your present or most
      recent job and any other relevant experience and specialist knowledge you have gained in paid
      or unpaid employment. Use the contents of the Job Description and Personal Specification
      as a guide, giving examples that you feel demonstrate how you meet the job requirements
      outlined. Please also include any other interests or activities you are involved in.




     If necessary please continue on a separate sheet(s) of A4 paper, placing your name in
     the TOP RIGHT corner and numbering the additional sheets.
9.    Rehabilitation of Offenders Act 1974


       An employer’s ability to make employment decisions based on an individual’s past criminal
       convictions is governed by the Rehabilitation of Offenders Act 1974. The Act specifies that
       after certain periods of time anyone who has been convicted of a criminal offence and who has
       served their sentence be not obliged to disclose past convictions. Any offender whose
       conviction has become ‘spent’ is known as a ‘rehabilitated’ person. However, there are certain
       convictions, depending on the nature of the punishment received and the age of the offender,
       for which a person can never become rehabilitated. These are outlined in Section 5 of the
       1974 Act.

       There is, however exceptions to these entitlements where the non-disclosure of past
       convictions in certain professions and employments would cause wider public concern. These
       exceptions are contained in the Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 /
       2001. By virtue of this Order potential employees for the following exempted occupations listed
       are legally obliged to disclose all past spent or unspent convictions.

               Registered teacher;
               Employment or other work which is concerned with the provision care services to
                vulnerable adults and where the worker has access to such adults in the course of his
                / her duties;
               Work in a ‘regulated position’ (covers wide range of jobs involving or in connection
                with children or vulnerable adults and work at establishments where these groups are
                present) or work in a further education institution where normal duties involve regular
                contact with persons under 18 years;
               Other (employer to specify)…………………………………………………………………

       The above list is not exhaustive and merely refers to areas or work that may be relevant to the
       Company’s business.

       Any information given will be treated confidentially and only considered in relation to the post
       for which you are applying.



10.   Disclosure of Criminal Background

      Please complete if the post for which you are applying provides access to children


       Please declare (in the space below) all information concerning any criminal convictions, bind-
       over orders or cautions that you may have received (including any which are spent) if the post /
       job for which you are applying is exempt in accordance with Section 4(2) of the Rehabilitation
       of Offenders Act 1974 by virtue of the (Exceptions) Order 1975 to that Act (as amended).

               Date                  Offence               Sentence - Order Caution




       In the event that you are offered the appointment it will be subject to a Criminal Record
       Background Check being made before the appointment can be confirmed. Failure to agree to
       such a check being made will mean that your application cannot be considered. Any
       information provided will be treated as strictly confidential and used only in consideration of
       your suitability for appointment.

       STATEMENT OF APPLICANT
       Any information I have provided above is full and accurate and I agree to be the subject of a
       Criminal Record Background Check if offered the appointment.


       Signed………………………………………………………….. Date……………………………………
11.   Asylum and Immigration Act 1996


      The Asylum and Immigration 1996 is intended to ensure that only those people legally entitled
      to live and work in the UK are offered employment. Under Section 8 of the Act it is a criminal
      offence to employ a person aged 16 or over who is subject to immigration control unless:

      1.      That person has current and valid permission to be in the UK and that permission does
              not prevent him or her from taking the job in question or
      2.      Asylum seekers who have been given written permission to work, or
      3.      Those appealing against a refusal of an application for further permission to stay.
              They will have letters from the Home Office confirming that they can be legally
              employed.

      In order to comply with the Act you will be asked to produce one of the documents listed below
      if you are offered employment. This is to check the immigration status of all successful
      applicants. A copy of the document will be kept on your personnel file.

              P45 or other relevant documentation stating the employee’s NI number;
              British certificate or a passport showing the holder to be a British citizen;
              Passport or identity card of the European Economic Area;
              Passport or other travel document endorsed to show that the holder is authorised to
               work in the UK;
              Certificate of registration or naturalisation as a British citizen.
      


12.   Additional Work


      If you are offered this job have you any other paid work?        YES / NO*
      *Delete as appropriate

      If YES, please state:

      Employer:

      Nature of Work:

      Number of Hours per Week (for the purpose of the Working Time Regulations 1998):
13.   References

      Please provide below the names and addresses of two people who are willing to act as
      referees. One of these must be your present or most recent employer who has
      knowledge of your skills and experience and will be able to comment on your ability to
      do the job you are applying for. Referees must not be related to you.

       Name:                                               Name:

       Position (job title):                               Position (job title):

       Work Relationship:                                  Work Relationship:

       Organisation:                                       Organisation:

       Address:                                            Address:



       Telephone:                                          Telephone:
       (Please include STD code)                           (Please include STD code)


      The Company has the final decision on whether references are ‘satisfactory’ and
      meet with Company requirements.


14.   Relationship to other Employees


       Are you related to any employee of the Acorn Care and Education Group?

       Yes               No    If yes, please give the following details.

       Name:                                                  Position held:

       Company / School / College / Department

       Nature of Relationship e.g. Husband / sister-in-law etc.:


15.   Facilities at Interview?


       It is the Company’s policy to make adjustments to working conditions and the physical
       environment where it is reasonable to do so, in full compliance with the Disability
       Discrimination Act 1995. Please give details of any adjustments you may require in relation to
       your interview, as we wish to ensure that any specific needs you have are met.




16.   Dates for Interview


       Please give dates on which you will NOT be available for interview, e.g. holidays:
        17.     Where did you see this vacancy advertised?




        18.     Declaration


                  I declare that to the best of my knowledge the information contained in this application is
                  complete and correct. I understand that should I conceal any material fact, I will, if engaged,
                  be liable to the termination of my contract of employment.


                  Signed:                                            Dated:




        OFFICE USE ONLY


Date Application Form       Does candidate require     References        Pre-Placement          Employment Offer
Received: (Date Stamp)      any special                Requested:        Health Check           Made:
                            adjustments, in relation                     Required:
                            to the DDA?                Date:                                    YES / NO
                                                                         YES / NO
                                                       Date:                                    Date:
                            YES / NO
                                                                                                Date Accepted:


                            Shortlisted:               References        Criminal Record        Notification of
                                                       Received:         Check Required:        Unsuccessful
                            YES / NO                                                            Application:
                                                                         YES / NO
No. of additional sheets:   Interview/s Date:          Date:                                    YES / NO
                                                                         Date Received:
                                                       Date:                                    Date:

				
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posted:9/15/2012
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