APPLICATION FOR EMPLOYMENT

Please complete all pages in black ink or type (this document is also available in electronic form).

Post for which you are applying:
Are you willing to be considered for other posts? Yes No

Please return the completed form to The Serendipity Centre, First Floor, Goodlands House, St Lukes Close, Hedge End, Southampton, Hampshire. SO30 2US or by e-mail to .

PERSONAL DETAILS
Family name:
Forename/s: / Also known as:
Title: / Date of Birth:
Home address:
Preferred method of contact: / Telephone (h):
Telephone (w): / Telephone (m):
E-mail:
National Insurance Number: / DfES No (if qualified teacher):
CURRENT OR MOST RECENT EMPLOYMENT
Employer’s name:
Employer’s address:
Start date: / Leaving date or notice required:
Position: / Current salary:
Duties and responsibilities:
Reason for leaving:


EMPLOYMENT HISTORY

Start with the most recent employment from the end of full time education. Please photocopy and attach additional pages as necessary providing the same information outlined below, ensuring any gaps in employment are clarified to ensure we comply with our Safer Recruitment procedure.

Start date: / Leaving date:
Employer’s name:
Employer’s address:
Position: / Salary on leaving:
Duties and responsibilities:
Reason for leaving:
Start date: / Leaving date:
Employer’s name:
Employer’s address:
Position: / Salary on leaving:
Duties and responsibilities:
Reason for leaving:
Start date: / Leaving date:
Employer’s name:
Employer’s address:
Position: / Salary on leaving:
Duties and responsibilities:
Reason for leaving:
Start date: / Leaving date:
Employer’s name:
Employer’s address:
Position: / Salary on leaving:
Duties and responsibilities:
Reason for leaving:
Start date: / Leaving date:
Employer’s name:
Employer’s address:
Position: / Salary on leaving:
Duties and responsibilities:
Reason for leaving:
Start date: / Leaving date:
Employer’s name:
Employer’s address:
Position: / Salary on leaving:
Duties and responsibilities:
Reason for leaving:

EDUCATION

Please state qualifications gained. Successful applicants will be required to produce evidence (as original or certified copies) of any qualifications.

Schools, Colleges, Universities or Institute of Further Education attended (including part-time) / Dates / Qualifications gained including subjects, grades or results expected
From / To
RELEVANT QUALIFICATIONS/CERTIFICATES/ACHIEVEMENTS
Include any short courses or work-based training that you have attended
Establishment or awarding body / Date(s) / Qualifications gained including subjects, grades or results expected
Membership and status of any relevant Professional or Technical Associations


REASON FOR APPLYING

The Serendipity Centre is a centre of excellence in the education and care of young people with behavioural, emotional and social difficulties. Please use this section to tell us why you are applying for this position, how you feel you meet the requirements of the Person Specification, and how you can enhance the quality of our provision.

GENERAL EXPERIENCE AND FURTHER INFORMATION

Please use this section to tell us about any voluntary work, roles of responsibility, social and leisure interests, and any other activities which you consider relevant to this position.

If you are a person with a disability but are unable to meet some of the job requirements, specifically because of your disability, please address this in this section. If you meet all the other criteria you will be short listed and we will explore jointly with you if there are ways in which the job can be changed to enable you to meet the requirements.


ADDITIONAL INFORMATION

Details:
Are you lawfully able to live and work in the UK? Yes No
Do you hold a current UK or EU driving licence? Yes No
Do you have any driving convictions? Yes No
If yes, please give details including dates:
Can you drive cars with a manual gearbox? Yes No
Are you willing to drive young people on off-site activities and appointments? Yes No
Do you know any member of staff who works for the Company? Yes No
If yes, please explain:
Do you know any young person at the Centre or in our care? Yes No
If yes, please explain:
Have you ever been the subject of a Child Protection Investigation or allegation? Yes No
If yes, please explain:
If appointed this will be:
Your only paid employment Your main paid employment Secondary paid employment

EMPLOYMENT CHECKS

Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975
The appointment for which you are applying involves substantial opportunity for access to children. It is therefore exempt from the Rehabilitation of Offenders Act 1974 (Exemption 1975). You are therefore required to declare any convictions or cautions you may have, even if they would otherwise be regarded as "spent" under this Act. The information you give will be treated in confidence and will only be taken into account in relation to an application where the exemption applies. The Director is also entitled, under arrangements introduced for the protection of children, to check with the police for the existence and content of any criminal record of the successful applicant. The disclosure of a criminal record will not debar you from appointment unless the Director considers that the conviction renders you unsuitable for appointment. In making this decision the Director will consider the nature of the offence, how long ago and what age you were when it was committed and any other factors that may be relevant. Failure to declare a conviction may, however, disqualify you from appointment, or result in summary dismissal if the discrepancy comes to light.
Have you any Allegations, Convictions, Cautions, Reprimands or Warnings given by the Police?
Yes No
If yes, please give details of the conviction(s), caution(s), reprimand(s) and warning(s) and the date(s) on a separate sheet and attach it with this form and note that all allegation, convictions, cautions, reprimands and warnings must be declared.
An Enhanced DBS Check is required for this post.
Do you have a current Enhanced DBS Certificate? Yes No
Are you registered on the UPDATE service Yes No
Certificate number: / Issue date:


REFERENCES

You are required to give the details of three people to act as referees. You should give the name of your Line Manager in your present or most recent employment as one referee (or your Head Teacher or Tutor if you are a College or University leaver). Please note that friends and relatives may not act as referees and all offers of employment are subject to receipt of satisfactory references.

Name: / Relationship:
Organisation : / Position held:
Address:
Telephone: / E-mail:
Name: / Relationship:
Organisation : / Position held:
Address:
Telephone: / E-mail:
Name: / Relationship:
Organisation : / Position held:
Address:
Telephone: / E-mail:
If you are selected for an interview we will wish to take up references. We would prefer to contact your referees beforehand as this simplifies the process.
Can we contact your referees prior to interview? Yes No

DATA PROTECTION

Applicants are informed that information given in this application will be used to create a file on you within the specific regulations of the Data Protection Act 1998.

DECLARATION

I declare that the above information is accurate to the best of my knowledge and I understand that the withholding or declaration of false information may affect my application or continued employment with The Serendipity Centre Ltd.

The company is authorised to obtain references to support this application before interview unless noted above. I release the company and referees from any liability caused by the giving and receiving of information.

Signed: Date :

Applicant

Applicants returning an electronic copy of this form will be required to sign it at interview.


PERSONNEL MONITORING INFORMATION (OPTIONAL)

The Serendipity Centre has an equal opportunities policy and is keen to ensure that it is working efficiently. The information you provide in this section will be used for statistical monitoring only and is not part of the interview selection process

1. Sex: Female Male / 2. Age:
3. Marital Status Single Partnered Married Divorced Widowed Separated
4. Country of Birth:
5 Ethnic Origin: Please indicate below (tick one box only)
White / Mixed / Asian or
Asian British / Black or
Black British / Chinese or other ethnic group
British / White and
Black Caribbean / Indian / Caribbean / Chinese
Irish / White and
Black African / Pakistani / African / Vietnamese
Turkish or Turkish Cypriot / White and Asian / Bangladeshi
Tamil
Any other white background / Any other mixed background / Any other Asian background / Any other black background / Any other ethnic group
7. Where did you see the post advertised/how did you hear of the vacancy?

Application for Employment Page 2 of 8

ST.RE.15 Oct 2016