767/11/07 www.dudleycol.ac.uk Application for Employment Name (forename first) Candidate Number (for Office use only) Post Applied for Post Reference Closing Date Please return this application form to: Human Resource Development Department, Dudley College ,The Broadway, Dudley,West Midlands. DY1 4AS Fax: 01384 363444 Putting learners and our community at the heart of all we do Dudley College Application for Employment Candidate Number (Office use only) ADVICE ON COMPLETING THIS FORM Please take great care in completing this form since the decision to shortlist for interview will be based entirely on the information you provide. All posts have a job description and person specification which lists the skills, knowledge and experience needed. Make sure you have both the job description and person specification before you complete the form; unless you clearly demonstrate in your application how you meet the requirements specified you may not be shortlisted. The form will be photocopied, so you should use black or blue ink. When you complete Section 5 you may wish to include experience/training/skills that you have obtained through employment, or at home, or within the community, which meet the requirements of the job description and person specification. In addition, you are invited to include within this section any other relevant information about yourself not included elsewhere. Pages 1, 6 and 7 of the form will be separated before shortlisting; the shortlisting panel will make their decisions on pages 2 to 5 without access to any personal information. The Application Form is also available in other formats, e.g. Braille. Should you require any other format or any assistance in completing the form, please contact the Human Resource Development Department. You should therefore not include a curriculum vitae with your application. Application for the Post of Post Reference No Section 1: Personal Details FULL NAME: Surname Other Names Mrs/Miss/Ms/Mr/Dr/Other Previous Surname Home Address Post Code Correspondence Address (if different from above) Post Code TELEPHONE: Home TELEPHONE: Business Daytime (only if we may contact you on this number) TELEPHONE: Mobile E-mail address Date of Birth National Insurance Number Page 1 of 7 www.dudleycol.ac.uk Candidate Number (Office use only) Section 2: References Please give full name and address of two referees who will be able to provide a reference on your professional capability and suitability for the post. One of them should be your present or most recent employer. REFEREE 1 REFEREE 2 Name Name Job Title Job Title Address Address Post Code Post Code Tel No. Tel No. Fax No. Fax No. Email Address Email Address Referee’s Relationship to you Referee’s Relationship to you May we seek reference prior to interview? Yes No May we seek reference prior to interview? Yes No Section 3: Current Post A Post Held Department Name of Employer Address of Employer Postcode Date Appointed to post Basic Salary Additional Allowance(s) Grade Page 2 of 7 Dudley College Application for Employment Candidate Number (Office use only) Give brief details of duties and responsibilities of your present or most recent post: Reason for leaving? How much notice are you required to give to your present employer? DETAILS OF PREVIOUS EMPLOYMENT If part time, please state number of hours per week. PLEASE LIST MOST RECENT FIRST. Annual Employer Name and Address Job Title Reason for Leaving Salary B C D E F Please note: You will be required to provide details of all periods of employment including dates from and to if successfully appointed. Do you have a full driving licence? Yes No Do you have regular use of a Yes No car/motorcycle? Do you hold a current First Aid At Work Certificate? Yes No Page 3 of 7 www.dudleycol.ac.uk Candidate Number (Office use only) Section 4: Secondary/Further Education and Examination Results QUALIFICATIONS (please specify full-time, part-time, sandwich courses etc.) PLEASE LIST MOST RECENT FIRST. Expected Grade School/College/University FT/PT Qualifications Obtained Achievement Date Achieved (MM/YY) 1 2 3 4 5 Please note: You will be required to provide evidence of all relevant qualifications if successfully appointed DETAILS OF MOST RECENT TRAINING COURSES ATTENDED Course Organising Body PROFESSIONAL MEMBERSHIP Please give details of any professional membership you currently hold: Are you a qualified teacher? Yes No If you hold a DfES number, please state below: If Yes, please indicate qualifications held: BEd Will this be your first teaching post? Yes No PGCE Cert Ed Special Subjects Offered: 7407 Stage 3 7407 Stage 2 7407 Stage 1 Other Page 4 of 7 Dudley College Application for Employment Candidate Number (Office use only) Section 5: All Posts Please summarise the reasons for your application and provide details of how you meet the requirements of the job description and person specification.You should refer to the criteria outlined in the job description and person specification sent with this form; these will be used in the selection process.You can demonstrate your suitability for the post using examples from previous work, vocational and voluntary experience.This information can be provided on a separate sheet if you wish; please make sure it is securely attached to the form. Page 5 of 7 www.dudleycol.ac.uk Candidate Number (Office use only) Section 6: Equality Monitoring GENDER: Male Female DISABILITY: Do you have a disability or condition that you would like the college to know about? Yes No If yes, is there any assistance you would like the College to provide at interview or for you to carry out this job? If you wish to take advantage of the law relating to disability and of the College’s policy regarding the employment of people with disabilities you must advise the College of your disability. Please give details of your disability: Are you currently eligible to work in the UK? Yes No To which of the following groups would you say you belong? (Please tick one box only) African Indian Other Bangladeshi Mixed White/Asian Pakistani Caribbean Mixed White/Black African White British Chinese Mixed White/Black Caribbean White Irish FOR MONITORING AND SALARY ASSESSMENT Dates of previous employment as listed in Section 3 (page 3). PLEASE LIST MOST RECENT FIRST. Dates employed Employer Name (MM/YY) to (MM/YY) A B C D E F Dates of each of the qualifications listed in Section 4 (Page 4). PLEASE LIST MOST RECENT FIRST. School/College/ Date gained Qualification University (MM/YY) 1 2 3 4 5 Page 6 of 7 Dudley College Application for Employment Candidate Number (Office use only) Section 7: Other Information Are you related or known to any member of Dudley College of Technology Corporation or member of staff? Yes No Name of Person Relationship (A candidate who fails to disclose such a relationship shall be disqualified from the appointment and if appointed could be liable to dismissal without notice) ANY CANVASSING WILL DISQUALIFY CANDIDATES Please state where you saw the post advertised (include newspaper title, journal title, website etc) Section 8: Disclosure of Criminal Background Successful candidates will be required to undertake an enhanced Criminal Records Bureau (CRB) Disclosure check. You are asked to give details of any convictions including those which for other purposes are 'spent' under the provision of the Act. If you are offered employment, then any failure to disclose such convictions could result in dismissal or disciplinary action by the College. All convictions must be included. If you have no convictions then please write 'none'. Date Police Convictions, Cautions, Reprimands and Final Warning Sentence Declaration I declare that the information given above and in any supporting documents is true and that nothing has been omitted that would affect the application. I understand that any false or misleading information given in this application may render my contract of employment, if I am appointed, liable to termination. I agree that information provided on this application form can be used for data processing as defined in the Data Protection Act 1998. Signed Date Dudley College actively promotes equality and celebrates diversity. Thank you for completing this application form.
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