Vacancies

Job Title / Position

Job Title / Position Applied for

Personal Details

Title —Please choose an option—MrMrsMsMissOther If "Other", please state First Name(s) Surname Any Previous Name(s) Date(s) from and to (for previous name if applicable) Additional information (Role & Personal Details)

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Identity

National Insurance Number Date of Birth Additional information (Identity)

Current Address

Current address (including postcode) Date from (at current address)

Previous Address (last 5 years)

Any previous address in the last 5 years (include postcode) Dates from and to (previous address) Additional previous address (optional) Dates from and to (additional previous address) Additional information (Address history)

Contact Details

Telephone — Home Telephone — Mobile Email Additional information (Contact details)

Holidays

Dates of holidays already booked Additional information (Holidays)

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Disabled Job Applicants – Positive Action and Access Requirements

Wherever possible, we will make reasonable adjustments to ensure that disabled applicants are not disadvantaged in our recruitment and selection process. When we talk about reasonable adjustments, we mean making provisions or alterations to the test or interview to remove any barriers faced by disabled applicants.

If you are a disabled person, and you meet all the essential criteria for the post you are applying for, you will be guaranteed a test/interview. Tell us here about any access requirements you may have, or reasonable adjustments you would like us to consider, should you be invited for an interview or test for this post.

Access requirements / reasonable adjustments (if any) Additional information (Access requirements)

Medical

Please also tell us if you have any Medical conditions at all, and if you think in your opinion they would affect your ability to work.

Medical conditions and impact on ability to work (if any) Additional information (Medical)

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Current Employer (or last employer if not currently employed)

Job title Pay & other benefits Employer's name and address Name & position of your Manager Date started Notice required, or date left Brief description of duties Reason for leaving (if applicable) Additional information (Current/Last employer)

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Previous Employment (since leaving school — most recent first)

Please include dates and reasons for any gaps in employment. Add more details on a separate sheet if needed.

Previous Employment 1

Employer (full postal address) Job Title Date From (MM/YY) Date To (MM/YY) Reason for leaving

Previous Employment 2

Employer (full postal address) Job Title Date From (MM/YY) Date To (MM/YY) Reason for leaving

Previous Employment 3

Employer (full postal address) Job Title Date From (MM/YY) Date To (MM/YY) Reason for leaving

Previous Employment 4

Employer (full postal address) Job Title Date From (MM/YY) Date To (MM/YY) Reason for leaving Explain any gaps in employment (dates + reason) Additional information (Previous employment)

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Qualifications

Qualification 1

School/College/University (including postal address) Date From (MM/YY) Date To (MM/YY) Qualifications gained Level (e.g. GCSE)

Qualification 2

School/College/University (including postal address) Date From (MM/YY) Date To (MM/YY) Qualifications gained Level (e.g. GCSE)

Qualification 3

School/College/University (including postal address) Date From (MM/YY) Date To (MM/YY) Qualifications gained Level (e.g. GCSE) Additional information (Qualifications)

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Membership of Professional Bodies

Professional Body 1

Professional Body Membership No. Membership Status Date Membership started

Professional Body 2

Professional Body Membership No. Membership Status Date Membership started Additional information (Professional memberships)

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Supporting Evidence / Statement (Required)

Please write your supporting statement Additional information (Supporting statement)

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STEP 6 — VERIFICATION, DRIVING, DBS, REFERENCES & DECLARATIONS

VERIFICATION INFORMATION

Disciplinary Action

Have you ever been the subject of a formal disciplinary sanction or investigation in your current employment?

YESNO

Are you in the process of on-going disciplinary proceedings or investigation in your current employment?

YESNO

Have you ever been the subject of a formal disciplinary sanction or investigation in any previous employment?

YESNO Details (if YES to any above) Additional information (Disciplinary)

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Driving Licence

Do you hold a current FULL UK Driving Licence?

YESNO If NO, please state which type you do hold (e.g. provisional, PSV etc.)

Do you have access to a vehicle to get to work?

YESNO

Do you have any spent/unspent motoring convictions?

YESNO Motoring conviction details (if YES) Additional information (Driving)

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Criminal Record

This position is exempt from the Rehabilitation of Offenders Act 1974. Therefore please list ANY cautions, reprimands, convictions etc.

Have you ever been cautioned or convicted by the Courts/Police for any criminal offence?

YESNO

Have you in the past, or are you currently, the subject of any police investigation for any criminal offence or following allegations made against you?

YESNO Details (if YES to any above — include offences, penalties, dates, country, and any driving offences) Additional information (Criminal record)

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Disclosure and Barring

Have you ever been disqualified or barred from working with children and vulnerable adults?

YESNO

Is there any reason you know of why you cannot work with children and vulnerable adults?

YESNO Details (if YES to any above) Additional information (Disclosure & barring)

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References (Three Required)

Please provide details of three people who are prepared to act as referees for you. References from family members will not be accepted.

First Referee (Current/Last Employer / Tutor)

Name Relationship to you

May we contact prior to interview?

YESNO Position held by Referee Organisation HR Manager (if known) Address Postcode Telephone no Email

Second Referee

Name Relationship to you

May we contact prior to interview?

YESNO Position held by Referee Organisation Address Postcode Telephone no Email

Third Referee (Must not be related)

Name Relationship to you

May we contact prior to interview?

YESNO Position held by Referee Organisation Address Postcode Telephone no Email Additional information (References)

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Monitoring — Voluntary & Confidential

Media Source — Where did you see/hear about this vacancy? Date of birth (optional)

Gender

MaleFemalePrefer not to say

Under the DDA definition, do you consider yourself to be disabled?

YesNoPrefer not to say

Do you consider yourself to be a disabled person as defined under the Social Model of Disability?

YesNoPrefer not to say Religion —Please choose an option—BuddhistChristianHinduJewishMuslimSikhNoneOtherPrefer not to say If "Other", please state Ethnic Origin (choose the closest match) —Please choose an option—BritishIrishOther WhiteWhite & Black CaribbeanWhite & Black AfricanWhite & AsianOther mixedIndianPakistaniBangladeshiOther AsianCaribbeanAfricanOther BlackChineseOtherPrefer not to say If selected "Other", please state Additional information (Monitoring)

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Applicant Signature

Signature of Applicant (type your full name) Name in Block Capitals Date

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Right to Work (UK)

I confirm that I am legally entitled to work in the United Kingdom and, if interviewed, I will produce the required documents.

I confirm I have the right to work in the UK and can provide documents if interviewed.

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Declarations

Data Protection Notification & Authorisation

The information you have provided in completing this application form will be used to process your application for employment. The Company will keep the information you have supplied confidential, and will not divulge it to third parties, except where required by law, or where we have retained the services of a third party representative to act on your/our behalf.

I have read and understood the Data Protection notification.

I confirm the information provided is correct and understand that false or misleading information may result in termination of employment if appointed.

Additional information (Declarations)

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