Office Use Only Applicant No. Gloucester City Council Post Number Post Name Part A: Personal Details and Equalities Closing Date Monitoring Data The Council is committed to developing fair and inclusive employment policies and to secure a workforce that reflects the community it serves. To ensure there is no unlawful discrimination, we need to monitor the recruitment process. The information you supply in Part A of the form will be kept separate from the application form before the selection process. PERSONAL DETAILS (Please print if submitting hard copy. You are advised to complete all sections of this form) National Insurance Number: _________________ Date of Birth:______________ Title (Mr/Mrs/Ms/Miss/Dr etc.): _________ First names:__________________________ Last name____________________ Address: __________________________________________________________ __________________________________________________________________ ____________________________________ Post code:____________________ Telephone numbers: (daytime): _______________ (home/mobile)_____________ Email: _______________________________________ Are you related to a Councillor or any employee of Gloucester City Council? (If so, please give details.) _________________________________________________ __________________________________________________________________________ REHABILITATION OF OFFENDERS ACT 1974 Have you any convictions that are not spent under the Rehabilitation of Offenders Act? (Please see information sheet.) YES NO If YES please give details:- _____________________________________________ ____________________________________________________________________________ ADVERTISING Where did you see this job advertised? _____________________________________ PREFERRED WORKING ARRANGEMENTS Full-time Annualised Hours Part-time Job share Term time only Definitions of the above categories are given on the Flexible Working Arrangements information sheet MONITORING INFORMATION Disability Do you consider you have a disability or impairment that needs to be taken into consideration in order to ensure that you have equal and fair access to employment? Yes No Decline to identify INTERVIEW ARRANGEMENTS Do you need any arrangements made for the interview e.g. to accommodate disability. If so, please specify: ___________________________________________________________________________ __________________________________________________________________ Age Please give your age Gender Which of the following best describes your gender? Male Female Ethnic Origin These are the categories used in the 2001 census. Choose a section and then indicate your category White Black or Black British Asian or Asian British British Caribbean Indian Irish African Pakistani Other White Other Black Bangladeshi Background Background Other Asian Background Mixed Chinese or Other Ethnic Group White & Black Caribbean Chinese White & Black African Other Ethnic Group White & Asian Other Mixed Background If you have indicated ‘Other’, please state your ethnicity_______________________ The Council recognises that sexual orientation and religion or belief are very personal and sensitive issues. However, in order to determine equality in recruitment and selection and whether the Council has a representative workforce, we need to monitor these areas. Sexual Orientation Which of the following best describes your sexual orientation? Bisexual Gay woman / lesbian Gay man Heterosexual / straight Other (if you feel categories unsuitable) Decline to identify Religion or Belief Which of the following best describes your religion/belief? Buddhist Christian Hindu Jewish Muslim Sikh Other religion No religion Decline to identify I declare that the information on this form is correct and that I agree to it being held and processed in accordance with the data protection Act 1998. Signature: Date: (If completing this form electronically, in submitting this form you are agreeing that the information on this form is correct, and to it being held and processed in accordance with the data protection Act 1998.) Gloucester City Council Office Use Only Applicant No. Post Number Part B: Application Form Post Name Closing Date Please complete all sections Post applying for: Post no. (if applicable) Service Unit: QUALIFICATIONS Academic / professional qualifications in date order (most recent first) Subject Qualification Grade Proof of professional qualifications will be required at interview Current membership of relevant professional or technical bodies and membership status WORK HISTORY CURRENT OR LAST JOB Name of employer___________________________________________________________ Address___________________________________________________________________ Job Title__________________________________ Period of Notice___________________ Dates from ____________________ To____________________ Brief description of duties / responsibilities Reason for leaving PREVIOUS JOBS (in date order, most recent job first) Name and address Job title and main duties Date Date Reasons for of employer from to leaving Do you have a full valid license to drive vehicles in the UK YES / NO INFORMATION IN SUPPORT OF YOUR APPLICATION Please give brief details of experience and training (including voluntary work) relevant to the post. Please refer to the person specification and job description. Please do not attach a C.V. You may continue on a separate sheet REFEREES (one of whom should be your present/last employer) If you are not in employment, please give a previous employer, head of school / college or someone who knows you well. Please ensure that your referees are in a position to respond promptly. If you believe there may be difficulty in obtaining references you should discuss the matter with the contact in the job advertisement. PRESENT/LAST EMPLOYER OTHER REFEREE Name Name Address Address Post Code: Tel. No: Post Code: Tel. No: May we contact referees prior to interview? YES NO Please note we will ask referees to confirm sickness levels Failure to disclose relevant information requested in this application form will disqualify a candidate and discovery of erroneous information after appointment may lead to dismissal. Applications will only be accepted from candidates eligible to work in the UK (please see enclosed information) Canvassing Councillors or any employee, either directly or indirectly, will disqualify you. I declare that the information on this form is correct and that I agree to it being held and processed in accordance with the data protection Act 1998. Signature: Date: (If completing this form electronically, in submitting this form you are agreeing that the information on this form is correct, and to it being held and processed in accordance with the data protection Act 1998.) Please ensure you have completed parts A and B and return the form to:- Gloucester City Council, Human Resources, North Warehouse, The Docks, Gloucester, GL1 2EQ, or as advised in the covering documentation. If applicable, please include the post number on the front of the envelope.
Pages to are hidden for
"SECTION FOUR"Please download to view full document