Children and Families

Application form

An equal opportunities employer

Please read the Guidance Notes at the end of this document to help you complete all sections of this form. Please note if you are not contacted within 4 weeks of the closing date your application may not have been successful.

Please save this form to your computer prior to completion.

Job reference number / Email your completed form to:
Job Title
Closing Date

1 Personal Details

Title / Surname
First name / Previous name
Full address / Mobile telephone
Postcode / Email address
Home telephone / National Insurance Number
Work telephone / GSCC Registration Number
Asylum and Immigration Act 1996 – Before you commence working you must provide evidence to demonstrate your right to work in the United Kingdom.
Are you eligible to work in the U.K? / Yes / No
Do you require a work permit/visa? / Yes / No
Nationality
Have you ever worked for Ealing Council
Ealing Council? / Yes / No
If yes, please say whether you were an agency worker, employee or a contractor
Are you still working for Ealing Council? / Yes / No / If Yes, enter your employee number
(you will find this on your pay slip)
If No enter the date you left
Department you work(ed) for / Job title
Reason for leaving
Are you related to a Councilor or any senior manager within the council / Yes / No
If yes, please give name

2 Advertising Monitoring

How did you find out about this vacancy?

(Please state whether Ealing’s website, Jobcentre Plus, print media and title, job board and title or referral)

3 References

Please give details of two referees, the first of which must be your current or most recent employer. If you have not worked for some time or have never worked, give the names of a professional who knows about what you can do and who can comment on your ability to do the job.

You may wish to give the names of teachers, lecturers, and other professionals (this must not be a relative). You have the right to view these references although the authorship must remain confidential.

Please note: The Council reserves the right to seek references from any previous employer/school/college or university and may take up more than two references, With Safeguarding, roles involving work with vulnerable groups, references may be taken up prior to interview.

First Referee

Name and title
What is this person’s personal or professional relationship to you? e.g. your manager/lecturer
Full address / Facsimile number
Postcode / Email address
Telephone number
You may / May not / Proceed with reference enquiries.

Please be aware for Safeguarding roles references may be required prior to interview.

Second Referee

4 Employment History

Please give us your full employment history (if necessary continue on a clearly marked separate page). You will need to explain the reason for any breaks in employment. If you have not had a paid job before or you have been out of work for some time, please provide details of any relevant voluntary work.

Present or Last Job

Name of organisation you work(ed) for
Your job title
Full address / Employed from / to
Postcode / Notice required
Telephone / Current Salary
Main Duties
Reasons for leaving

Previous Jobs

Name of organisation you worked for
Your job title
Full address / Employed from / to
Postcode
Main Duties
Reasons for leaving

Previous Jobs continued

Name of organisation you worked for
Your job title
Full address / Employed from / to
Postcode
Main Duties
Reasons for leaving

Please continue on a clearly identified separate page if necessary

5 Rehabilitation of Offenders Act 1974

Posts involving work which brings you in regular contact with children, vulnerable adults, people with disabilities and learning difficulties are exempt from the provisions of the Rehabilitation of Offenders Act 1974. If you are applying for work in this area you are required to inform us whether or not you have any criminal record, convictions, cautions, reprimands, final warnings, bindovers, pending summons or prosecutions whether or not they are regarded as spent. Those appointed to work with children or vulnerable adults will also be subject to a clearance report from the Criminal Records Bureau. Having a criminal record will not necessarily prevent your employment.

Have you ever been disqualified from working with children or vulnerable adults?

Yes .No

If yes, please give details on a clearly marked separate page.

I am applying for a post which involves working with one of the groups detailed above and I have a conviction or caution for which I attach details on a clearly marked separate page.

Yes No

If you are applying for other employment, for example, not working with vulnerable groups as above, do you have any convictions or cautions that are NOT SPENT, or criminal prosecution(s)

Yes No

If yes, please give details on a clearly marked separate page.

6 Education and Training

Please give details of any education or training you have received which is relevant to the job you are applying for. You should tell us what relevant qualifications or certificates you have. Original certificates must be produced at interview stage, if the qualification is necessary to the job you are applying for.

Dates / Course title or subject/s studied / Qualifications/Certificates
From / To
From / To
From / To
From / To
From / To
From / To

If necessary, please continue on a clearly marked separate page.

7 Relevant Short Courses Completed

Please give details of any short or part-time training courses you have attended which may be relevant to the job.

Course title / Dates / Certificate
From / To / Yes / No
From / To / Yes / No
From / To / Yes / No
From / To / Yes / No
From / To / Yes / No
From / To / Yes / No

8 Relevant Experience, Skills and Abilities

You need to read the person specification which forms part of the role profile. Considering every point of the person specification, please explain how your experience, skills and abilities make you suitable for this job.

If necessary, please continue on a separate page(s) marked with your name and noting that this is part of section 8- Relevant Experience, Skills and Abilities.

Your experience may have been gained through previous jobs, voluntary and/or community work, spare time activities and/or training.

9. Disability & Reasonable Adjustments

Ealing Council is committed to employing disabled people and has been awarded the Two Ticks Disability Symbol by Jobcentre Plus. Under this scheme one of our commitments is to interview any applicant with a disability provided their application demonstrates that they meet the minimum essential requirements for the advertised vacancy.

Ealing Council is committed to ensuring equality of opportunity to all applicants and employees and in the provision of services. To monitor how well we are doing you are asked to provide the following information: -

Disability

The Disability Discrimination Act 1995 defines a person as having a disability if she/he “has long term physical or mental impairment which has a substantial and long term adverse affect on his/her ability to carry out normal day-to-day activities.” We are actively seeking to employ people with disabilities. To assist with this we are committed to making reasonable adjustments at the interview stage including nearby parking, someone to meet you at the entrance of the building, a sign language interpreter at interview and preferred type of seating.

Please note that we offer special arrangements for considering applicants with disabilities. Please see our website for fuller information www.ealing.gov.uk/jobs

Do you consider yourself to have a disability? Yes No

If you have a disability, are there adjustments that we could make to offer you a fair selection interview? Yes No

Please give details of any adjustments required:

10 Data Protection Act 1998

The information given on this form will form part of the contract of employment for successful candidates. We may contact other relevant organisations to check factual information you have given on this application form. The information will be stored manually and electronically and disposed of after 12 months if your application is unsuccessful.

The council is under a duty to protect the public funds it administers, and to this end, should the council employ you, it may use the information you have provided on this form within this authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for this purpose of protecting those funds.

The Act gives you the right to see a copy of the information held about you on application to the Council’s Data Protection Officer. Details are available on the Council’s website:

http://www.ealing.gov.uk/services/council/data_protection/

11 Declaration

I declare that the information given on this form is correct to the best of my knowledge and belief and I understand that any false statement on this form is an offence and could result in my application being taken not being taken any further. I agree that the information I give you in connection with this application for employment may be stored and processed as part of your HR practices and management.

Date
Signed

Monitoring information

Ealing Council is committed to ensuring equality of opportunity to all applicants and employees and in the provision of services. To monitor how well we are doing, you are asked to provide the following information. Information supplied will be anonymised in any reporting:

Applicant Name
Applicant Reference No / Job Reference No
Age (in years) / Date of Birth

I am Female Male

Are you today of the same gender you were assigned at birth Yes No

Ethnic Background

Choose one section from (A) to (E) then put an X in the appropriate box to indicate your Ethnic Background.

A White

British / Irish / Irish Traveller/ Gypsy

Any other white background please specify

B Black Or Black British

Caribbean / African / Any other black background please specify

C Mixed

White and Black Caribbean / White and Black African / White and Asian / Any other mixed background please specify

D Asian Or Asian British

Indian / Pakistani / Bangladeshi / Chinese

Any other Asian background please specify

E Other Ethnic Group

Arab / Any other ethnic background please specify

What is your religion?

Buddhist: / Christian: / Hindu: / Jewish: / Any other, please specify:
Muslim: / Sikh: / None: / Prefer not to disclose

What is your sexual orientation?

Bisexual: Gay: Heterosexual: Lesbian: Prefer not to disclose:

12 Guidance notes on completing your application form

Please read these notes carefully as the decision to invite you to an interview will depend on the information you provide on your form. Please put an X in the relevant boxes.

1 Information about you

It is important that you fill in this section accurately and in full.

2 Advertising monitoring

We are interested in how you found out about this role and would appreciate it if you could state where you saw this vacancy.

3 References

References from your current, or most recent employers will be required before any offer of employment is confirmed. You may wish to give the names of teachers, lecturers, and other professionals (this must not be a relative). For roles involving work with vulnerable groups, references may be taken in advance of interview.

4 Employment History

Starting with your current or last job, list the main duties of the jobs you have held. This information may be used to assess whether you meet the person specification for the job. Any breaks in employment should be explained in full.

5 Rehabilitation of Offenders Act 1974

Ealing Council has a duty to protect children, vulnerable adults, people with disabilities and learning difficulties. This section must be answered truthfully and in full. Information provided may be checked.

6/7 Education, training and relevant short courses completed

List all your qualifications and training courses you have attended. This information may be necessary to assess whether you meet the requirements for the job. Please ensure nothing important is omitted. Where a qualification is an essential requirement, you may be asked to bring your original certificate if you are invited for an interview.

8 Relevant Experience, Skills and Abilities

This is the most important part of your application, as this is where you make your case for being given the job. Provide examples for each point on the person specification to show that you have the skills and experience required.

9 Disability & Reasonable Adjustments

Ealing Council is committed to employing people with disabilities. If you have a disability, please give details of any adjustments you require for the selection process or for the job.

We are actively seeking to employ people with disabilities. To assist with this we are committed to making reasonable adjustments at the interview stage including nearby parking, someone to meet you at the entrance of the building, a sign language interpreter at interview and preferred type of seating.

10 Data Protection

Under the terms of the Data Protection Act 1998 the information you give us will only be used for the stated purpose.

11 Declaration

Any false statement on this form would be deemed an offence and could result in the application not being taken further, or offer of employment withdrawn, or disciplinary action leading to dismissal will be taken (if employment has commenced).

12 Monitoring Information

Please ensure that you complete the monitoring information as it is essential for the Council to determine whether its equality and diversity policy is working. This page will be detached prior to shortlisting.

v. December 2011