"EMPLOYMENT APPLICATION Roles Working With Children and or Vulnerable Adults"
EMPLOYMENT APPLICATION Roles Working With Children and/or Vulnerable Adults – Support Staff Should Leave NonRelevant Sections Blank Please complete this form in Black Ink or Typescript to assist with photocopying 1 APPLICATION FOR APPOINTMENT AS Post No: Location Post Title School / Establishment / Business 2 PERSONAL DETAILS First Name(s) Surname & Title MR / MRS/ MISS / MS / REV Former Name(s) Home Address Date of Birth DAY/MONTH/YEAR Home Telephone Work Telephone Mobile Telephone Post Code If you would like us to communicate with you via E-mail please provide your address: Fax Contact Number General Teaching Council Registration No. General Social Care Council Registration No. DCSF No. Date you obtained this Qualification / Registration 3 CURRENT POST (Or most recent Employment) Employed From DAY/MONTH/YEAR Establishment / Business Name Date Left DAY/MONTH/YEAR Full Mailing Address Telephone No. Notice Period Post Code Post Title Salary £ Email Grade Salary Spine Point Brief outline of your Duties in this post 4 CURRENT POST (Continued) Foundation TO BE COMPLETED BY EDUCATION APPLICANTS ONLY Independent LA Group Size of School Please indicate whether your CURRENT POST (as shown above) was: Boys Girls Mixed Ages Taught Number on Roll Salary Spine Points Are you currently receiving TLR, SPA or Other Points? Page 2 of 7 5 PREVIOUS TEACHING EXPERIENCE NAME / TYPE OF SCHOOL EXACT START/ END DATES TO BE COMPLETED BY EDUCATION APPLICANTS ONLY NO. on ROLL Boys/Girls/Mixed [Please indicate whether LA /Foundation/Independent (Most recent first) POST HELD AGES TAUGHT SUBJECTS Please continue on a separate sheet if needed. Please maintain the format shown above (Section 5) 6 PREVIOUS EMPLOYMENT EMPLOYERS NAME & FULL MAILING ADDRESS (Most recent first) EXACT START/ END DATES JOB TITLE & BRIEF DETAILS (NATURE OF YOUR WORK) F/T or P/T SALARY GRADE REASON FOR LEAVING Please continue on a separate sheet if needed. Please maintain the format shown above (Section 6) Confidential - application_form_vulnerable.doc Page 3 of 7 7 SECONDARY & FURTHER EDUCATION (Subjects passed with Grades e.g. O/A Level / GCSE / GNVQ) SCHOOL or COLLEGE ATTENDED: SUBJECTS TAKEN (Most recent first) EXAMINATION RESULTS GRADES EXACT DATES YOU STARTED & LEFT THIS ESTABLISHMENT 8 HIGHER EDUCATION (Qualifications e.g. Degree / Certificate / Diploma, etc) PLACE OF STUDY (Most recent first) EXACT DATES YOU ATTENDED MAIN SUBJECTS SUBSIDIARY SUBJECT(S) QUALIFICATION GAINED Including Class 9 OTHER RELEVANT TRAINING COURSES / DEVELOPING ACTIVITIES (Attended in the last 5 years) COURSE DETAILS EXACT DATES YOU ATTENDED Confidential - application_form_vulnerable.doc Page 4 of 7 10 PROFESSIONAL QUALIFICATIONS QUALIFICATION DETAILS EXACT DATE YOU OBTAINED THIS QUALIFICATION 11 HEALTH How many periods of Sickness Absence have you had over the past two years? How many working days has this amounted to? Have you been granted Infirmity Retirement by the Department of Children, Schools and Families? EXPLANATORY DETAILS (if relevant) If YES please state the date YES NO 12 HAVE YOU AT ANY TIME BEEN FULLY OR PARTIALLY DEBARRED OR RESTRICTED FROM WORKING WITH CHILDREN, YOUNG PEOPLE AND/OR VULNERABLE ADULTS? YES NO If YES, please enclose details with dates in a sealed envelope and attach to this form 13 WHERE DID YOU SEE THIS POST ADVERTISED? Please state the name of the publication or source where you saw this post advertised 14 YOUR SUPPORTING STATEMENT As part of your Employment Application you are requested to set out (on a separate sheet(s) of paper) relevant information in support of your application. This should demonstrate how you consider you are able to fulfill the requirements of the Job Profile and Person Specification for this post. 15 LEISURE ACTIVITIES & INTERESTS Please give brief details of your recreational, or any other specialist, interests that you consider may be relevant to this post ACTIVITY & HOW LONG HAVE YOU BEEN PARTICIPATING IN THIS ACTIVITY Confidential - application_form_vulnerable.doc Page 5 of 7 16 HOLIDAYS Please give details of any holiday or other commitments, which may affect possible interview and appointment dates COMMITMENT & DATE (S) YOU ARE UNAVAILABLE 17 REFERENCES PLEASE READ THIS NOTICE CAREFULLY You must supply full mailing addresses and contact details so that we may obtain two Employment References. Your first Employment Reference A must be from your current, or, most recent employer. Your second Employment Referee B must be from a different former employer - and must be from a former employer that is familiar with your work with children/vulnerable adults where this applies. University leavers must supply full mailing addresses and contact details so that we may obtain two Character References. Your first Character Reference A must be from your University Course Tutor. Your second Character Reference B must be someone upstanding in the community that has known you for the past five years. This person should not be a family member, partner or anyone living in your household. If you are known to any of your Referees by any other name, please include details below. Please note that references will be taken up if you are Short-listed for this post. All appointments are ‘subject to receipt of satisfactory references in writing’. A EMPLOYMENT REFERENCE CHARACTER REFERENCE B EMPLOYMENT REFERENCE CHARACTER REFERENCE Referees Name Contact Mailing Address Referees Name Contact Mailing Address Post Code Contact Telephone Email Known As Post Code Contact Telephone Email Known As 18 CANVASSING Are you related to a Governor of the establishment to which your application is being made, or to a Councillor, or Senior Officer of Thurrock Council? Failure to disclose a family relationship may disqualify your Employment Application. Person’s name Person’s name Their relationship to you Their relationship to you YES NO 19 ASYLUM AND IMMIGRATION ACT 1996 YES NO Do you have the legal right to live and work in the UK? Please give your National Insurance Number If you are invited to interview you will need to bring with you evidence of your legal right to live and work in the UK. Your passport, birth certificate or confirmation of your National Insurance Number, are acceptable documents. Should these not be available we will notify you of other appropriate documents. Confidential - application_form_vulnerable.doc Page 6 of 7 20 EQUAL OPPORTUNITIES We aim to ensure that people are recruited, selected, employed, trained and promoted on their abilities for the job. 21 DISCLOSURE OF CRIMINAL CONVICTIONS PLEASE READ THIS NOTICE CAREFULLY Because of the nature of the work for which you are applying, this post is Exempt from the provisions of the Rehabilitation of Offenders Act 1974. As you are seeking employment in a capacity which provides the opportunity for access to children, young people and/or vulnerable adults, unless you are already employed by Thurrock Council, or one of its Schools, in this capacity currently, you must disclose – at the time of application – all criminal convictions, bind-overs or cautions, including any that may be ‘spent’, under the Rehabilitation of Offenders Act 1974. In the event of employment failure to disclose any such convictions, bind-overs or cautions, including any that may be ‘spent’ could result in dismissal or disciplinary action by the Council or School Governing Body. It is particularly important therefore that you read carefully the document entitled ‘The Disclosure Process’, which is included with this Employment Application. If you have not received this document, please contact the sender immediately, or alternatively Thurrock Council on (01375) 652965, and request the document before your completed employment application form. Please enclose full details and dates of all criminal convictions, bind-overs or cautions, including any that may be ‘spent’ in a sealed envelope attached to this form. If offered the post you will be required to give your consent to the Council to undertake an Enhanced Criminal Records Bureau Disclosure to identify whether there exists any record, criminal conviction, partial or full debarring or restriction from working with children, young people and/or vulnerable adults. 22 DECLARATION YES NO I have answered YES to Section 12 ‘Debarring & Restrictions’ and have enclosed details with dates in a sealed envelope attached to this form. I have read Section 14 ‘Your Supporting Statement’ and attached pages in support of my application. I have read and understood Section 21 ‘Disclosure of Criminal Convictions’. I have received, read and understood ‘The Disclosure Process’ document. I have Disclosures as documents in Section 21 ‘Disclosure of Criminal Convictions’ and enclose details with dates in a sealed envelope attach to this form. I understand if I am offered this post I will be required to give my consent for the Council to undertake an Enhanced CRB Disclosure. YES NO YES YES NO NO YES NO YES NO I certify that to the best of my belief, the information I have entered is true, and I understand that any false information or failure to disclose may, in the event of employment, result in dismissal or disciplinary action by the Council or School Governing Body. Applicant’s Signature Date Signed The purpose for collecting your personal details on this form is to allow the Council to process your job application. Once the form has been completed the Council will store the details on the recruitment computer database and will also be held in manual form within Human Resources. Access to the information provided will be on a strictly need to know basis and the information will be retained for 6 months post appointment for unsuccessful candidates before being securely disposed of. This information will not be shared with any other organisations/partners. If this changes, your permission will be sought. Confidential - application_form_vulnerable.doc Page 7 of 7 RECRUITMENT MONITORING FORM This form should be returned with your application form, but will be removed from your application prior to short listing. 1 POST DETAILS Post No Location Post Title School / Establishment / Business 2 PERSONAL DETAILS First Name(s) Surname & Title MR / MRS/ MISS / MS / REV Former Name(s) Gender Date of Birth DAY/MONTH/YEAR Female Male Age 3 White ETHNIC GROUP – to which of the following groups do you belong? (Please tick). Mixed Parentage White & Black Caribbean White & Black African White & Asian Asian/Asian British Indian Pakistani Bangladeshi Chinese British Irish Black or Black British Caribbean African Other Any Other Group – please state 4 DISABILITY DISCRIMINATION ACT 1995 “A physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities.” Do you regard yourself as being disabled within the terms of the Act? Yes No Where you have a disability or condition is there anything we should be aware of to help us to assess your application fairly? Are there any special arrangements we need to make should you be invited for interview or offered the job? Confidential - application_form_vulnerable.doc