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 USEONLY
DoyoucurrentlyworkforSandwell
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:

1

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

2

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

3

Thispageisdeliberatelyleftblank.

4

Jobtitle: / Applicationno: / OFFICE USEONLY
Referenceno:

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

5

Section4:Experience

Pleasecompletethefollowing,startingwithyourcurrentemploymentandincludeall employment.Anyemploymentwithtemporaryworkagenciesmustshowtheagencyas theemployeraswellasthebusinesswheretheworkwascarriedout.Pleasealso includeanybreaksinemploymenthistorytogetherwiththereasonforthebreak.Please completethefollowingaccuratelyandincludeallexperiencesincetheageof16,or sinceleavingfulltimeeducation.

Currentjob/posttitle:Tutor
Nameaddressofemployer:
Postcode:
Salary/wage:Grade/scale:
Howlonghaveyouworked/
didyouworkthere? / From:To:
Pleasestatenumberofyears:
Doyoustillworkthere: / Yes / No
IfYES,periodofnoticerequired?
IfNO,reasonforleaving

6

Date / Employersnameaddress oryouractivityifyouare/were notemployed / Positionheld / Reasonfor leaving/breakin employment
From
Mth/Yr / To
Mth/Yr

PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerofthepage.

7

Section5:SupportingInformation

Pleaseusethispagetooutlineanyotherinformationthatmayhelpyourapplication. Continueonaseparatepageifnecessaryandattachitwithonestapleinthetopleft- handcorner.

PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerofthepage.

8

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 / Comments

Section7: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 / Fish4JobsWebsite
LocalNewspaper / Regional Websitewmjobs.co.uk
NationalNewspaper / FromFriendorColleague
SpecialisedPublication / Sandwell’sJobsOpportunityBulletin
Sandwell’sJobsWebsite / Other,pleasespecify
Monster’sJobsWebsite

N.B.Canvassingforthisappointmentwilldisqualifyyourapplication.

Pleasecheckthatallsectionsofthisformhavebeencompletedandandifreturningby post,thatyouhavesignedthedeclarationonthebottomonpage3.Ifyoue-mailthis formyouwillbeaskedtosigntheformifyouareinterviewed.

10