CONFIDENTIAL
School Non-Teaching Application Form
Please note that CV’s cannot be accepted
Please complete ALL Sections of this form as appropriate,
and for ease of photocopying, complete in Type or Black Ink.
Please note sections 1, 2 & 3 of this application form will be removed prior to shortlisting.
Returnthecompletedformto:
Jobtitle: / Applicationno: / OFFICE USEONLYDoyoucurrentlyworkforSandwell
MetropolitanBoroughCouncil? Yes No
AreyouontheAtRiskRegisterfor
SandwellCouncil,SandwellLeisureTrust
orSandwellHomes? Yes No
Referenceno:
Closingdate:
Section1:PersonalDetails
Title: / Day/WorkTelephone:Firstname(s): / E-Mailaddress:
Lastname: / Dateofbirth:
Formername(s): / NINumber:
Homeaddress:
Postcode: / Detailsofpersontocontactinanemergency
NameAddress:
Postcode:
HomeTelephone: / EmergencyTelephone:
IfyouareapplyingforaSocialCarepost,areyou
registeredwiththeGeneralSocialCareCouncil(GSCC)?YesNo
IfYES,whatisyourGSCCRegistrationno:
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Section2:EqualOpportunities
Aspartofourequalopportunitiespolicywerequestthatyoucompletethefollowing information.Thisinformationisusedformonitoringpurposesonly.Allinformationwill betreatedasconfidentialandwillnotbeusedwhenshortlistingordecidingonwhether anapplicantissuccessfulorunsuccessfulinobtainingemployment.Theinformation youprovidewillhelpustoensurethatourrecruitmentproceduresarefairbyallowing ustoidentifyandeliminatepotentialareasofdiscrimination.
EthnicOrigin
Prefernottosay
AsianorAsianBritish-Bangladeshi
AsianorAsianBritish-Indian AsianorAsianBritish-Pakistani BlackorBlackBritish-Caribbean MixedEthnic-WhiteAsian
MixedEthnic-WhiteBlackCaribbean
OtherEthnicGroup-Arab
White-Irish
White-Welsh/English/Scottish/N.Ireland
Anyotherethnicgroup(notlisted) AsianorAsianBritish-Chinese AsianorAsianBritish-Other BlackorBlackBritish-African BlackorBlackBritish-Other
MixedEthnic-WhiteBlackAfrican
MixedEthnicGroup-Other White-GypsyorIrishTraveller White-Other
OtherEthnicGroup/comments
Religion/Belief
Buddhist Hindu Muslim Other
Sikh
Christian Jewish None
Prefernottosay
Disability
TheEqualityAct(2010)definesadisabledpersonassomeonewithaphysicalormental impairmentwhichhasasubstantialandlong-termadverseeffectonhis/herabilitytocarryout normalday-to-dayactivities.
Doyouconsideryourselftohavesuchadisability? YesNo
DisabilityCategory
HearingImpairment
LearningDisability
Learningdifficulties
MentalHealthCondition
continuedonPage3
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Neurologicalcondition
Physicalco-ordinationdifficulties Reducedphysicalcapacity Speechimpairment
Prefernottosay
Visualimpairment(notcorrectby spectaclesorcontactlenses)
Mobilityimpairment
Other
Physicalimpairment Sensory impairment None
Long-standingillnessorhealthcondition
Pleaseidentifyanyspecialrequirements,adjustmentsorequipmentwhichmayassistyou
(a)intherecruitment (b)toenableyoutocarryoutthejob
Gender
Female
Prefernottosay
Male
AgeRange
16-17
25-29
40-49
60-64
18-24
30-39
50-59
65+
SexualOrientation
Bisexual
Heterosexual/straight
Lesbian/Gaywoman
Gayman
Prefernottosay
Tothebestofyourknowledge,areyourelatedtoanyCouncilMemberand/ortoany employeeofSandwellMetropolitanBoroughCouncil?Ifso,pleaseexplain:
DoyouhavealegalrighttoliveandworkintheUK?YesNo
Ideclarethat,tothebestofmyknowledgeandbelief,theinformationIhaveprovidedistrue. Iunderstandthatanyfalseinformationorfailuretodiscloseanycriminalconvictionswill result,intheeventofemployment,inadisciplinaryinvestigation,andmayresultindismissal.
Signed:Date:
PLEASENOTESECTIONS12OFTHISAPPLICATIONFORMWILLBEREMOVEDPRIORTOSHORTLISTING
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Thispageisdeliberatelyleftblank.
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Jobtitle: / Applicationno: / OFFICE USEONLYReferenceno:
Section3:Education,TrainingQualifications
Secondary/Further
Date / School/College/University(NameAddress) / ExaminationResults
(Subject,LevelandGrade)
From
Mth/Yr / To
Mth/Yr
Academic/Professional
Date / College/University(NameAddress) / ExaminationResults
(Subject,LevelandGrade)
From
Mth/Yr / To
Mth/Yr
Relevanttraining(includingshort,in-servicetraining)
Date / College/University/TrainingProvider(NameAddress) / CourseTitle/Results
From
Mth/Yr / To
Mth/Yr
Otherqualifications,membershipofprofessionalbodies
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Section4:Experience
Pleasecompletethefollowing,startingwithyourcurrentemploymentandincludeall employment.Anyemploymentwithtemporaryworkagenciesmustshowtheagencyas theemployeraswellasthebusinesswheretheworkwascarriedout.Pleasealso includeanybreaksinemploymenthistorytogetherwiththereasonforthebreak.Please completethefollowingaccuratelyandincludeallexperiencesincetheageof16,or sinceleavingfulltimeeducation.
Currentjob/posttitle:TutorNameaddressofemployer:
Postcode:
Salary/wage:Grade/scale:
Howlonghaveyouworked/
didyouworkthere? / From:To:
Pleasestatenumberofyears:
Doyoustillworkthere: / Yes / No
IfYES,periodofnoticerequired?
IfNO,reasonforleaving
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Date / Employersnameaddress oryouractivityifyouare/were notemployed / Positionheld / Reasonfor leaving/breakin employmentFrom
Mth/Yr / To
Mth/Yr
PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerofthepage.
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Section5:SupportingInformation
Pleaseusethispagetooutlineanyotherinformationthatmayhelpyourapplication. Continueonaseparatepageifnecessaryandattachitwithonestapleinthetopleft- handcorner.
PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerofthepage.
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Convictions
RehabilitationofOffendersAct1974(exceptions)Order1975
Ifyouhavebeenconvictedofanyoffence(s),orifthereareanyproceedingspending againstyou,pleasegivedetails.
IfthePersonnelSpecificationadvisesyouthataCriminalRecordsBureaucheckwillbe required,thepostyouareapplyingforiscoveredbytheRehabilitationofOffendersAct
1974(exceptions)Order1975.Thismeansthatyoumustdeclareallconvictions,including cautions,reprimandsandformalwarningsforanyoffence(s)whichforotherpurposesare
‘spent’undertheprovisionsoftheAct.
Failuretodiscloseanypreviousconvictions(includingcautions)reprimandsandformal warningscouldresultindismissalshoulditbesubsequentlydiscovered.Anyinformationgiven, eitherwhenreturningthisapplicationformorataninterviewwillbeentirelyconfidentialand
willbeconsideredonlyinrelationtothisapplication.
Date / TypeofOffence / Sentence/FineImposed / CommentsSection7:References
Pleaseprovidedetailsbelowoftworeferees(oneofwhommustbeyourpresentormost recentemployer)whoareabletocommentonyoursuitabilityfortheposition:
Name: / Name:Address:
Postcode: / Address:
Postcode:
Telephoneno: / Telephoneno:
E-Mailaddress: / E-Mailaddress:
Occupation: / Occupation:
IfyouhavepreviouslybeenemployedbySandwellCouncil,theunitinwhichyouworkedwill beaskedtoconfirmdetailsofyouremployment,includingthereasonforyourleaving.
Maywecontactyourcurrentemployerat
thisstagewithoutfurtherreferencetoyou?YesNo
Section8:DataProtectionAct
TheinformationyouareprovidingwillbeusedbySandwellMetropolitanBoroughCouncilin connectionwithyourapplicationandforassessingyoursuitabilityforthepostadvertised. The informationwillbesharedonlyincompliancewiththelawandforthepurposeofmonitoring
theCouncil’spracticestoensureequalityofopportunity.
IfIamappointedtoworkwithSandwellMBC,Igivemypermissionformynameandcontact detailstobeprovidedtotherecognisedTradeUnionsinSandwell(pleasetickasapplicable).
Yes No
Section9:How didyoufindoutaboutthisvacancy?
Pleaseindicatewhereyoufirstsawinformationaboutthisvacancy.
JobCentre / Fish4JobsWebsiteLocalNewspaper / Regional Websitewmjobs.co.uk
NationalNewspaper / FromFriendorColleague
SpecialisedPublication / Sandwell’sJobsOpportunityBulletin
Sandwell’sJobsWebsite / Other,pleasespecify
Monster’sJobsWebsite
N.B.Canvassingforthisappointmentwilldisqualifyyourapplication.
Pleasecheckthatallsectionsofthisformhavebeencompletedandandifreturningby post,thatyouhavesignedthedeclarationonthebottomonpage3.Ifyoue-mailthis formyouwillbeaskedtosigntheformifyouareinterviewed.
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