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									                                                                 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.

								
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