Application Form Online An Equal Opportunity Employer
Please read the Guidance Notes before completing this form Post Title: Grade: Department: Division:
SECTION A: PERSONAL DETAILS Title: Full Name: Present Address: 1 All Previous Names:
Contact E-mail: Home Tel. No: National Insurance No: Business Tel. No:
SECTION B: CURRENT OR MOST RECENT EMPLOYMENT Name of Current or most Recent Employer: Address:
County: Postcode:
Date Appointed: Period of Notice Requried: Leaving Date (if applicable):
Current Salary: £
Current Job Title: Job Title of person to whom you report: Details of Duties and Responsibilities:
Reasons for leaving or seeking other employment:
Section C – PREVIOUS EMPLOYMENT (Detail most recent employment first) FROM: (Date) TO: (Date) Name of Employer: Your Job Title of Duties:
Reason for leaving:
SECTION C – PREVIOUS EMPLOYMENT FROM: (Date) TO: (Date) Name of Employer: Your Job Title of Duties:
Reason for leaving:
SECTION C – PREVIOUS EMPLOYMENT FROM: (Date) TO: (Date) Name of Employer: Your Job Title of Duties:
Reason for leaving:
SECTION C – PREVIOUS EMPLOYMENT FROM: (Date) TO: (Date) Name of Employer: Your Job Title of Duties:
Reason for leaving:
SECTION D – EDUCATION AND TRAINING Name of Course Full Time Part Time Subject and Level Grade Achieved Date
Membership of Professional, Craft or Similar Bodies:
SECTION E – DETAILS IN SUPPORT OF YOUR APPLICATION Please use this section to show how your experience and achievements meet the requirements set out in the Job Description and Person Specification. Include relevant skills and experience gained in previous employment, work experience placements school and further education, and from voluntary and community work or hobbies. (Please continue on separate sheets if necessary).
SECTION F – REFERENCES Your current or most recent employer must be one of your referees. The Authority reserves the right to contact any of your previous employers for reference, if an offer of employment has been made to you or is contemplated. Relatives are not acceptable, even if they are your employer. Name: Job Title: Name: Job Title:
Address:
Address:
Business Tel No: Business Fax No: Email: May we contact at this stage: Yes No
Business Tel No: Business Fax No: Email: May we contact at this stage: Yes No
If you were known to your referee by another name please give details:
If you were known to your referee by another name please give details:
SECTION G – MISCELLANEOUS INFORMATION Are you related to or the partner of any Councillor or employee of the Council YES NO
If YES, please give brief details: Such a disclosure will not disqualify you from consideration. However, a failure to disclose any such relationship or the canvassing of Councillors or employees of the Council in relation to this appointment may disqualify you, or may be dealt with under the appropriate procedure, which may include the Disciplinary Procedure. Please see the enclosed information for Applicants.
Have you ever worked for Southend-on-Sea Borough Council before? YES NO
If YES, please give details
Please state how many days, within the last two years, that you been absent from work or incapacitated due to sickness/injury:
The information stated un this application, together with any accompanying papers is, to the best of my knowledge, correct. I understand that a false entry may lead to either an offer of employment being withdrawn or disciplinary action being taken, which could result in dismissal
Full Name:
Date:
In the interest of economy, we will only contact the applicants selected for interview. Thank you for your interest in this post.
EQUAL OPPORTUNITY MONITORING FORM ONLINE An Equal Opportunity Employer
YOUR DETAILS: Southend-on-Sea Borough Council fully supports the principle of equal opportunities in employment and firmly opposes all forms of unlawful or unfair discrimination on the grounds of colour, race, and nationality, those with dangerous transmittable diseases (eg. Hepatitis & HIV), ethnic or national origin, gender, marital status, sexuality, age, disability, trade union membership, religious belief and offending background. To monitor the effectiveness of our Equal Opportunities Policy you are asked to complete this questionnaire and return it with your completed application form. The information provided will be treated in confidence and further guidance is provided in the guidance notes.
Post Applied For: Full Name: Date of Birth: Gender: MALE FEMALE
1. ETHNIC INFORMATION The Council had adopted the ethnic codes recommended by the Commission for Racial Equality. To which of these groups do you consider you belong? (NB: Please tick one box only) A. WHITE
British English Scottish Welsh Irish Any other White Background
B
MIXED
White and Black Caribbean White and Black African White and Asian Any other Mixed background, please write in:
C Indian
ASIAN, ASIAN BRITISH, ASIAN ENGLISH, ASIAN SCOTTISH OR ASIAN WELSH
Pakistani Bangladeshi Any other Asian background, please write in:
D
BLACK, BLACK BRITISH, BLACK ENGLISH, BLACK SCOTTISH, BLACK WELSH
Caribbean African Any other Black background, please write in:
E
CHINESE, CHINESE BRITISH, CHINESE ENGLISH, CHINESE SCOTTISH, CHINESE WELSH, OR OTHER ETHINC GROUP
Chinese Any other background, please write in:
2. DISABILITY DISCRIMINATION ACT (1995) Do you describe yourself as having a disability in accordance with the Disability Discrimination Act? (see guidance notes below):
DISABILITY DISCRIMINATION ACT (1995) Under the Disability Discrimination Act 1995, a person is disabled 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. A substantial adverse effect is something which is more than a minor or trivial effect. A long term effect of an impairment is one: o Which has lasted at least 12 months; or o Where the total period for which it lasts is likely to be at least 12 months; or o Which is likely to last for the rest of the life of the person affected. o In addition, two further categories of person are considered disabled for the purposes of the Act. First, a person who has had a disability within the meaning of the Act but has since recovered. Second, a person who has registered disabled under the Disabled Persons (Employment) Act 1944 on 12 January 1995 and at 2 December 1996. Those specifically excluded from the act include: Addiction or dependency on alcohol, nicotine, or any other substance (other than as a result of the
substance being medically prescribed). Seasonal allergic rhinitis (e.g. Hayfever), except where it aggravates the effect of another condition. A visual impairment which is or can be corrected by wearing contact lenses or glasses.
3. HOW DID YOU BECOME AWARE OF THIS VACANCY It would be helpful if you could indicate how you became aware of this vacancy by ticking the appropriate box. Internal Vacancy List Specialist/Trade Magazine Local/Free Newspaper National Press Other (please specify): Southend-on-Sea Borough Council Internet Site Other internet site Job Centre Jobs Go Public
CONFIDENTIALITY The Provision of the information contained on this form is entirely voluntary and will in no way affect your application. It is collected to help the Council ensure that its recruitment arrangements are fair, and to monitor the effectiveness of our Equal Opportunities Policy. The information that you provide will be treated in the utmost confidence and will only be used for statistical purposes. The information provided by the successful candidate will then become part of their personal record as an employee of the Council and will be entered on the Council's secure personnel database. The information will be used to help monitor the effectiveness of the Council's Equal Opportunities Policy. Information will be provided to authorised agencies such as the Office of Statistics, but only in the form of overall statistics, and will not contain information that can be traced to named individuals.