| CONFIDENTIAL
SUPPORT STAFF APPLICATION FORM
Please use black ink/print when completing this form
1.
Application for the post of: at:
(School/ College/ Children's Centre)
2.
Last
Name
First Names
Title Any Previous Last Names
Address
Post Code:
Daytime tel. no. Evening tel. no.
Email:
3. Education (Secondary, Further / Higher)
Establishment (name and town) From To Qualifications / Grade / Date awarded
4. Job related training (include membership of professional institutes, vocational and non-vocational courses)
Institute / Courses studied From To Standard or level achieved
and date awarded
5. Employment history
If this is going to be your first job after leaving school or college you may like to give details of any holiday, weekend, evening jobs or work experience placements. A continuous employment history is required from when you left full-time education.
Current employer
Employer's name/dept
Address Postcode
Post held Date appointed
Salary Grade (if applicable)
Other allowances
Notice period
Previous experience (most recent employer first). Please include details of gaps in employment here.
Employer's name
and type of business Post held Date Reason for leaving
From
Month Year To
Month Year
6. Reasons for applying for this post
7. Experience and personal skills
Please give details of all your experience, skills and abilities relevant to the post applied for.
If you have had a break from paid work it is important to include details of any voluntary work or unpaid duties you have performed, particularly any positions of responsibility held, eg parent governor, playschool assistant, committee member, VSO, treasurer of a club, CAB volunteer etc. Attach a continuation sheet if necessary.
8. Additional relevant interests (Such as membership of any club, leisure activities and hobbies)
9. References
Please give details below of two people who can provide information that will confirm your suitability for this post. Where appropriate one person should be your current or most recent employer; the other should be someone who has known you in a professional capacity. References will be sought on short listed candidates and previous employers may be contacted to verify particular experience or qualifications before interview. Current or previous employers will be asked about disciplinary offences relating to children including penalties that are "time expired" and any child protection concerns.
Name Position
Address Postcode:
Daytime tel. no. Email:
Name Position
Address Postcode
Daytime tel. no. Email:
10. Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975
This post is covered by the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 because it is a post which involves working directly with children or young people. You are therefore required to declare whether you have any criminal convictions (or cautions or bind-overs) including those which are "spent".
Have you ever been convicted of any criminal offences warned or reprimanded in or been officially cautioned relation to any such offence? YES NO
Are you included in any list of people barred from working with children by the Independent Safeguarding Authority (ISA) or the General Teaching Council? YES NO
If Yes, please give details including dates, on a separate sheet, place the sheet in a sealed envelope marked for the attention of the Chair of the shortlisting panel and enclose it with this form.
PLEASE NOTE;
. If your application is successful, prior to taking up your post, you will be required to undergo a Formal Disclosure process through the Criminal Records Bureau. This will require you to complete a separate CRB application form and to provide a range of more than one piece of documentary evidence of your identity.
. Although a criminal record involving offences against children is likely to debar you from appointment of this type of post, the existence of other criminal convictions will not necessarily be a bar to employment.
. Any criminal record information arising out of the disclosure process will be discussed with you before any final decision is made about your employment.
. It is a criminal offence to apply for or accept a position (paid or unpaid) working with children if you are excluded from such work by virtue of a court order or exclusion by the ISA.
. Copies of the County Council's policy on the employment of ex-offenders and the CRB Code of Practice are available on request.
. Copies of disclosure certificates are retained by the Local Authority until after the commencement of employment. The fact that a disclosure has been processed, with dates, is then recorded on our computerised personnel record system and the disclosure certificate itself is destroyed, in accordance with the Data Protection Act 1998.
11. Where did you see the advertisement for this post?
12. Further information and declaration
Do you hold a full UK driving licence? YES NO
Would you have use of a car for work? YES NO
Would you require sponsorship ( previously a work permit) to take up this post YES NO
National insurance number
Canvassing in any form may disqualify you from employment. If you have a direct relationship with a County Councillor, Senior Manager of Hampshire Children's Services Department, or a governor or senior employee of a school maintained by this Authority. Please state their name(s) and the nature of the relationship.
I understand that if I am appointed, personal information about me will be computerised for personnel / employee administrative purposes including analysis for management purposes and statutory returns.
In signing this form I give my authority for use of my personal data for these purposes.
I hereby confirm that the information I have given above is true.
I understand that, should any of the particulars I provide in this application be found to be false within my knowledge, or should there be any wilful omission of material fact, this may be reported to the Police as well as leading to my application being rejected or the contract being null and void if I have already been appointed.
Signature of Candidate Date
October 2010
CONFIDENTIAL
Equalities Monitoring Form
We would be grateful if you would complete the following in order for us to monitor equalities information and ensure that we are treating all candidates fairly and appropriately.
This information will be treated confidentially and will not be used in any part of the selection process.
School/ Children's Centre:
Post applying for:
Name:
Date of Birth:
Gender: Male Female
Nationality: British Irish
Other EU country Other Non EU country
Ethnicity:
Please indicate your ethnic origin:
A White B Mixed C Asian & Asian British
English / Welsh / Scottish / Northern Irish / British White & Black Caribbean Indian
Irish White & Black African Pakistani
Other White background * White & Asian Bangladeshi
Gypsy/Irish Traveller Other Mixed / Multiple Ethnic background * Other Asian background *
Chinese
D Black & Black British E Arab or any other ethnic group
Caribbean Arab I do not wish to disclose
my ethnic origin to
African
Any other ethnic group * Hampshire County Council
Other Black background *
CONFIDENTIAL
* Please indicate any other ethnic background:
Sexual Orientation:
Please indicate your sexual orientation:
Heterosexual Transsexual Bisexual
Gay Lesbian Other
I do not wish to disclose my sexual orientation to Hampshire County Council
Disability
Disability is described by the Equality Act 2010 as a physical or mental impairment that has a substantial long term adverse effect on an individual's ability to carry out normal day to day activities.
Applications from disabled people are welcome. We will ensure that appropriate support is provided where required, both in the recruitment and selection process, and during employment.
Do you consider yourself to have a disability?
Yes No I do not wish to disclose my disability data to
Hampshire County Council
Thank you for completing this form.
Please return in a sealed envelope with your application form
stating your name, post applying for and the School/ Children's Centre.
The above information will not be shared with the selection panel prior to interview.
This information will be retained, confidentially, and used for payroll/ monitoring purposes.
STRICTLY CONFIDENTIAL
Hampshire County Council - Education Department
PARK COMMUNITY SCHOOL
Employment checks in respect of application for appointment involving working with children.
Details overleaf to be completed by all candidates (or volunteers) and submitted with application form.
In accordance with statutory requirements and Hampshire County Council policy employment checks are conducted for positions involving working with children (including young people and vulnerable adults). Information obtained through this process will be used for the protection of these groups and not to discriminate unfairly against those with convictions which are irrelevant or unrelated to this application. This process will be conducted against HCC policy and the Criminal Records Bureau Code of Practice.
It is a criminal offence to apply for a position working with children if you are excluded from such work by virtue of a court order or exclusion by the Department for Education and Skills or Department of Health. This applies to all work, paid or unpaid and under a contract or otherwise. Your signature at the end of this form will be regarded as confirmation that you are not excluded from working with children.
The position for which you are applying, with the privileged access it gives to children, is also an exempted occupation under the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. This means that you must disclose spent convictions and specifically you are required to indicate whether you have convictions and/or cautions, reprimands or warnings on the reverse side of this sheet.
We will, through the Criminal Records Bureau, make a check to establish any criminal/caution record upon offer of appointment. Accordingly, successful applicants will be required to complete a Criminal Records Bureau disclosure form. Appointment to the position for which you have applied will be subject to completion of a satisfactory Criminal Records Bureau check at the following level:
Enhanced disclosure
If you have any queries concerning the requirements for positions working with children, young people or vulnerable adults or the Criminal Records Bureau disclosure process please contact the recruiting school.
To be completed by applicants for positions working with children and returned with application form.
Name (in full)
(Please complete in Block Capitals)
Date of birth
Are you currently an employee of Hampshire County Council?
YES NO (Please tick as appropriate)
Have you been subject to a Criminal Records Bureau disclosure process within the last three months?
YES NO (Please tick as appropriate)
Have you been convicted at a Court or Cautioned by the Police for any offence at any time?
YES NO (Please tick as appropriate)
If YES, please provide details of spent and current convictions(s) or caution(s) or reprimands or warnings including date(s), Court or Police who dealt with the matter (continue on a separate sheet if necessary).
Declaration: I understand that this work is subject to a Criminal Records Bureau disclosure process and I am aware that spent convictions will be disclosed. I hereby confirm I am not excluded from working with children and that the information I have given above is true.
Signature Date |