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					EMPLOYMENT APPLICATION FORM CONFIDENTIAL
NAME: POST APPLIED FOR: WHERE DID YOU SEE THE VACANCY ADVERTISED:

This document is available in large print and other formats from any of the Council Offices by telephoning 01246 242430 . Please bear in mind we will need a few days to arrange this facility. If you need help to read this document please do not hesitate to contact us.
Bolsover District Council is committed to the promotion and implementation of equalities as an employer and in all the services provided to all sections of the community. In support of this the Equalities Policy and Racial Equalities Scheme are available on the Authority's website or as a hard copy on request. Disabled applicants meeting the essential criteria will be guaranteed an interview. NOTES FOR APPLICANTS: An application form is used because it allows us to process your application more quickly. The form directs applicants to provide certain pieces of information in a standardised order, which means that short-listers can easily find their way to specific information and gaps in the information can be easily spotted. The forms are designed to eliminate discrimination. Selection for interview will be based solely on the information given in the application form. 1. Study the job description and person specification carefully as you must show in your application how you can demonstrate the skills, knowledge and experience set out in the person specification. Those making the selection for interview will not assume that you have any of the attributes if you do not evidence them on your application form. Those who most closely match the person specification will be those who are selected for interview. It is very important that you complete ALL sections of the form before the closing date shown. A C.V. will not be accepted. The application form must be completed in full. Failure to do so will result in your application being disregarded. If you receive no further communication within four weeks of the closing date please assume you have not been successful and accept the Council's thanks for your interest. Personal information is requested from job applicants to assist in the recruitment process. Information provided by you on this application form may be copied for use during the recruitment procedure. Once the recruitment procedure is completed, the data will be kept on relevant job files for twelve months before being confidentially destroyed, unless applicants specifically request to the contrary. If you are the successful candidate, relevant information may be taken from this form and used as part of your personnel record and may be shared with other council departments or third party organisations. Approved travelling and subsistence expenses will be reimbursed to candidates invited for interview. During the first six months of employment you will be regularly reviewed and a decision will be made as to your suitability for the post. The Council operates a NO SMOKING POLICY for its employees / councillors. Applicants should note therefore that no provision will be made for new starters to smoke at work. Non EU overseas applicants MUST possess a valid UK work permit. For workers with

2.

3. 4. 5. 6.

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7.

8.

limited leave to remain in the UK a further check of documents will be made within twelve months of commencement date. If this post is exempted under the Rehabilitation of Offenders Act, disclosure of all criminal record information including details of "spent" convictions, cautions, reprimands and final warnings will be requested. If this post if subject to enhanced disclosure, the relevant law conviction information, such as police enquiries and pending prosecutions will be asked for. The Equal Opportunities monitoring information will be removed prior to the short listing process.

All personal information provided to Bolsover District Council will be held and treated in confidence in accordance with the Data Protection Act 1998. It will only be used for the purpose for which it was given and may be shared with other agencies, such as the Audit Commission or other local authorities for data matching purposes.

PERSONAL DETAILS SURNAME:

FORENAMES:

ADDRESS:

POSTCODE: TELEPHONE NUMBER (HOME): TELEPHONE NUMBER (DAY TIME/WORK): MOBILE NUMBER: E-MAIL ADDRESS:

May we contact you at work, with discretion? YES NO Do you have any special requirements which we can help you with in order to make the application process easier for you?

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EMPLOYMENT RECORD - CURRENT EMPLOYMENT

Please give details of your current employment DATES EMPLOYER‟S NAME AND NATURE OF BUSINESS POSITION HELD AND MAIN RESPONSIBILITIES REASON FOR LEAVING

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EMPLOYMENT RECORD - PREVIOUS EMPLOYMENT

Please give details of your previous employment, explaining any periods of unemployment DATES EMPLOYER‟S NAME AND NATURE OF BUSINESS POSITION HELD AND MAIN RESPONSIBILITIES REASON FOR LEAVING

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EDUCATION AND TRAINING HISTORY Please attach photocopies of any further education or professional qualifications. Original documents will need to be produced on appointment. GCSE/GCE QUALIFICATIONS Subject

Level

Date

FURTHER EDUCATION DEGREES AND DIPLOMAS Qualification Awarding Body

Date

PROFESSIONAL QUALIFICATIONS and any other relevant studies you have completed or are currently undertaking Qualification How obtained Date

RELEVANT TRAINING (please continue on a separate sheet of paper if necessary) Course Date(s) and Duration

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STATEMENT OF APPLICATION Please give your reasons for applying for this position and explain in what way you meet the criteria set out in the person specification. You will find the guidance notes in the Recruitment Pack useful in completing this section of your application.

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GENERAL INFORMATION Current salary and any other benefits

Notice requirement

Do you possess a current driving licence? If yes, please state which type of licence is held: Do you own or have access to a car/motorcycle? Please give details of any endorsements:

YES

NO

YES

NO

Do you require a work permit? YES NO If Yes, valid documents will need to be produced at interview. For workers with limited leave to remain in the UK a further check of documents will be made within twelve months of commencement date. National Insurance Number: Please give details of any conviction, other than those which are „spent‟ under the provision of the Rehabilitation of Offenders Act 1974. Failure to disclose such convictions could result in dismissal. Any information given will be treated in the strictest confidence.

Please note that certain areas of the Council‟s work are exempt from the provisions of the Rehabilitation of Offenders Act 1974 by virtue of the (exemptions) order 1975. Spent convictions must be declared for applications in relation to the following posts: Solicitors, Chartered or Certified Accountant. Any employment in the following establishments: Sports or Leisure Facilities.

The Council is committed to reducing sickness absence levels amongst it's employees. Any candidate who has had 20 or more working days sickness absence in the last 12 months will be offered the post on a 12 month probationary period, subject to them achieving a satisfactory level of attendance. A satisfactory level of attendance being 5 or less working days lost due to sickness absence. How many days have you had off work due to sickness, during the last twelve months? Please give details: (including whether any of this sickness was due to disability or maternity related sickness)

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REFERENCES Please give details of two referees, one of whom should be your last employer. Name: Name: Job Title: Full Address inc. Postcode: Telephone Number: E-mail: Job Title: Full Address inc. Postcode: Telephone Number: E-mail:

IF YOU ARE CHOSEN FOR INTERVIEW MAY WE CONTACT YOUR REFEREES YES NO If you are related to any Elected Member or Employee of the District Council, please give their name and your relationship to them.

NOTE: The Council will disqualify any applicant who directly or indirectly seeks the support of any Councillor / Officer for any appointment with the Council. Do you want to be considered for a JOB SHARE? YES NO

(You do not need to identify a job share partner) SECONDARY EMPLOYMENT Do you have any paid or unpaid secondary employment? If yes please provide brief details.

YES/NO

DECLARATION I declare that I have read and understood all the information provided with this application. For the purposes of the Data Protection Act 1998, I consent to the information contained in this form, and any information received by or on behalf of Bolsover District Council relating to the subject matter of this form, being processed by them in administering the recruitment and appointment process. I understand that any offer of appointment and subsequent employment is dependant upon this declaration and information contained within this application. To the best of my knowledge and belief the information contained in this form is accurate. It is understood that any deliberately false statement or omission may prejudice my employment. I understand that the appointment may be subject to a satisfactory medical examination. Signed: Date:

(NB: if this form is sent electronically you will be required to sign it, if you are shortlisted, at the interview)

Please advise us of any other information relevant to the recruitment process e.g. dates when you are not available, any special requirements you may have.

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EQUAL OPPORTUNITIES MONITORING INFORMATION General Information 1. Bolsover District Council wants to make sure that everyone has equal access to our employment opportunities. In line with legal requirements and Government recommendations all job applications are monitored by collecting confidential information from all applicants. 2. Please complete the information over the page. The information will then be detached from your application and stored securely and confidentially. It will not, under any circumstances be seen by anyone involved in assessing your application. 3. If you would like to discuss any aspect of the Council‟s Equality policies, please contact the Equality and Diversity Officer on 01246 242407. 4. Discrimination on the grounds of sex, marital status, age, race, disability, religion/belief or sexual orientation is illegal. Equality monitoring helps employers ensure that there is no indirect discrimination occurring in the recruitment process. The monitoring information also helps us to improve our policies and practices. 5. Please note that the race questions are not about place of birth or citizenship. UK citizens can belong to any of the groups indicated e.g. White, African, Caribbean, Indian, Pakistani or other group. 6. All disabled applicants are guaranteed an interview if they meet the minimum essential requirements for the job in the Person Specification. In addition, under the Disability Discrimination Act 1995, we are required to provide reasonable adjustments for disabled people during the recruitment process. 7. Your application will be assessed solely on your skills and ability to do the job.

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EQUAL OPPORTUNITIES MONITORING INFORMATION The Authority seeks to recruit employees on the basis of their suitability for a position and aims to ensure that consideration of colour, race, ethnic or national origin, religion, gender, marital status, disability, sexual identity, age, HIV or part time working should play no part in this process. To assist the Authority in monitoring the effectiveness of this policy, please complete the following:FULL NAME: ADDRESS (INC POSTCODE):

AGE RANGE (PLEASE CIRCLE): 16-24 MALE/FEMALE:

25-39

40-49

50+

MARITAL STATUS:

To which ethnic group do you belong? Choose ONE section from A to E, then tick the appropriate box to indicate your cultural background. A. WHITE British Irish Any other White background B. MIXED White and Black Caribbean Any other Mixed background

(please specify)

White and Black African (please specify)

White and Asian

C. ASIAN OR ASIAN BRITISH Indian Pakistani Any other Asian background (please specify) D. BLACK OR BLACK BRITISH Caribbean African Any other Black background (please specify)

Bangladeshi

E. CHINESE OR OTHER ETHNIC GROUP Chinese Any other background (please specify) Do you consider yourself to be disabled? (The Disability Discrimination Act 1995 states that “A person has a disability for the purposes of this Act if they have a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities”). Would any specialised aids help you to work more effectively? eg access, signer, speech amplifier If Yes, please specify What Religion Are You? Christian Buddhist Hindu Jewish Muslim Sikh

Yes No Yes No

Any other Religion Sexuality Heterosexual

No religion at all

Prefer not to say

Gay

Lesbian

Bisexual

Prefer not to say

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