Application form

Personal information

Name:

Address:

Telephone number:

e-mail:

Position applied for:

How did you become aware of this position?

Education

Please provide details and dates of education with any qualifications achieved and grades, including further & Higher education. (Please continue on a separate sheet if necessary)

Full record of secondary schools, colleges or universities attended / Full or part time / From / To / Exams passed and qualifications gained (including NVQs) including grades

Training

Please provide details of Professional Qualifications/ Training. (Please continue on a separate sheet, if necessary.)

Course title / Date / Qualification (if appropriate)

Employment

Please describe in detail your most recent employment, including areas of responsibility, duties and dates employed

Job title:
Salary:
Description:
Start date:
Name and address of employer:
Reason for leaving?
How much notice do you need to give?

Employment history

Please provide details and dates of your employment history, include dates and reasons for leaving. (Please continue on a separate sheet, if necessary.)

Name and address of employer / Job title and main duties / From / To / Reasons for leaving / Final salary

Gaps in employment or training

Date from / Date to / Reason for gap

Sickness absence

How many episodes of sickness have you experienced within the last 2 years?
How many days sickness have you taken within the last 2 years?

Further information

Please tell us why you are interested in this position and why you feel you would be a suitable candidate for the post. (Please continue on a separate sheet, if necessary)

References

Please state the names of 2 professionals we can contact to provide references for you. One must be your current employer. We will contact these persons if you are short-listed for interview.

Name & Address:
Telephone number: / Name & Address:
Telephone number:
e-mail: / e-mail:
Job Title: / Job Title:
Relationship to you: / Relationship to you:

I confirm that all the information I have given above is true.

Signature:

Date:

Please return to: The Board of Trustees

Brentry & Henbury Children's Centre

Brentry Lane

BRISTOL

BS10 6RG

Closing date for applications:17th June 2015

Equal Opportunities in Recruitment Processes

Disability

With reference to the Disability Discrimination Act definition:

Do you consider yourself to be a Disabled person?Yes / No

Ethnic origin Please note that these categories reflect those used in the 2001 Census.

How would you describe your ethnic origin? (If you do not identify with any of the categories listed, please use one of the “other” categories.) Please tick one box.

White / WU / British
WI / Irish
WO / Other white
Mixed / MC / White and black Caribbean
MA / White and black African
MS / White and Asian
MO / Other mixed
Asian or Asian British / AI / Indian
AP / Pakistani
AB / Bangladeshi
AS / Other Asian
Black or Black British / AC / Caribbean
AA / African
AO / Other black
Chinese or other / AH / Chinese
OE / Other ethnic group
UU / Don’t know/not sure
RF / Would rather not state
Religion/belief / Sexual orientation
How would you describe your religion/belief? / How would you describe your sexual orientation?
C / Christian / H / Heterosexual
B / Buddhist / G / Gay/lesbian
H / Hindu / B / Bisexual
J / Jewish / U / Don’t know/not sure
M / Muslim / R / Would rather not state
S / Sikh
O / Other
N / None
U / Don’t know/not sure
R / Would rather not state
Date of Birth:
The collection of equalities information conforms with employment provisions in the Sex Discrimination Act (1975), the Race Relations Act (1976) and the Disability Discrimination Act (1995). / Please return the completed form via email to:
or by post to:
The Board of Trustees
Brentry and Henbury Children’s Centre
Brentry Lane
Bristol
BS10 6RG