Candidate Application Form
Please complete in block capitals
Section 1. Personal Information
Mr/Mrs/Miss/Ms/Dr/Other
/Surname
/Forenames
Former Names (if any)Address
Postcode
Home Tel. No / Mobile
Email Address
National Insurance Number / Date of Birth
Do you require a work permit? Yes/No / If you already hold a work permit when does it expire? Date (DD/MM/YY)
Do you have a full driving licence? Yes/No / Car
PCV please state class ………………......
LGV/HGV please state class…………......
Do you have use of a car? Yes/No
SECTION 2. PRESENT OR MOST RECENT EMPLOYMENT
From DD/MM/YY / To DD/MM/YY / Employer/Company Name & AddressContact Name
Contact Email
Contact Tel Number
Your Job Title
Main duties
Reason for leaving
Present/Final Salary / Notice Period
SECTION 3. PREVIOUS FULL EMPLOYMENT HISTORY
(Most recent job first please). Please give full information from the date you left secondary education.
FromMM/YY / To
MM/YY / Job title & main duties / Name and Address of Employer / Salary on leaving / Reason for leaving
SECTION 3. PREVIOUS FULL EMPLOYMENT HISTORY
CONTINUED… Attach a separate sheet if necessary
FromMM/YY / To
MM/YY / Job title & main duties / Name and Address of Employer / Salary on leaving / Reason for leaving
SECTION 4. CURRENT/PREVIOUS VOLUNTARY/UNPAID WORK
Attach a separate sheet if necessary.
FromMM/YY / To
MM/YY / Duties / Organisation / Reason for leaving
SECTION 5. EDUCATION
SECONDARY (CSE, GCSE, RSA, A-LEVELS OR EQUIVALENT)
You may be asked for original evidence of your qualifications and we reserve the right to approach any education providers to verify the qualifications stated.Establishment / Subject / Level / Grade / Date of exam/award
FURTHER & HIGHER (DEGREE/DIPLOMA/BTEC/C&G/NVQ, ETC OR EQUIVALENT)
We may ask for original evidence of your qualifications and we reserve the right to approach any education providers to verify the qualifications stated.Establishment / Subject / Level / Grade / Date of exam/award
SECTION 6. PROFESSIONAL QUALIFICATIONS
Qualification Gained / Date of Exam/Award DD/MM/YYYYMEMBERSHIP OF / REGISTRATION WITH PROFESSIONAL BODIES
Professional Body / Membership Status / Registration Number / Renewal Date (DD/MM/YYYY)SECTION 7. TRAINING
Section 9 – TYPES OF CASUAL WORK SOUGHT
(Please tick all that apply and give more details where asked)
ADMINISTRATION / CLERICALReceptionist
Data entry
PA/ Secretary
Minute Taker
Other (please specify)
......
CUSTOMER SERVICE
Call Centre
Face to Face
Retail
Other (please specify)
......
FINANCE / BENEFITS / ACCOUNTS
Accountant Technician
Accountant
Other (please specify)
......
PROFESSIONAL
(please specify)
......
TECHNICAL (please specify)
...... / WASTE / CLEANING / WAREHOUSE
CATERING / CAFÉ WORK
LIBRARY WORK
LEISURE (please specify)
......
IT (please specify)
First and Second Line Desk Analyst
System Engineer
System Support
Other (please specify)
......
DRIVING (please specify licence)
DCPC (Driver Certificate of Professional Competence Training)
PCV/ LGV
Minibus
Other (please specify)
......
OTHER (please specify)
......
Section 8. Availability
What date can you start work? (please do not apply more than 3 months before you are available)DURATION (tick one box only) / AVAILABILITY (Please tick)
No limit / am / pm / night
Occasional days only / Monday
Short term only / Tuesday
Long term only / Wednesday
Thursday
Friday
Saturday
Sunday
Are you registered with any other agency? / YES / NO
If YES which one(s)?
Where was the work based at?
What was the pay rate?
SECTION 9. FURTHER SUPPORTING INFORMATION (personal qualities and experience making you suitable for temporary work, your approach to work).
Attach a separate sheet if necessary.
Section 10. References and Declarations
References
Please supply the names and addresses of two people to whom we may write for references.
One of these must be your current employer if you have one or most recent employer if not.
References will not be accepted from relatives or from people writing solely in the capacity of friends. Both referees should be able to comment on your work. Please ask permission from your proposed referees prior to naming them. By including a direct email for your references will considerably speed up the application process.
As this position involves working with children, any number of your previous employers may be contacted without seeking further permission from you in relation to your employment history as part of the vetting process (this includes vetting of internal candidates).
Both references will be taken up prior to interview.
Referee 1
/Referee 2
Name (including title) / Name (including title)Position / Position
Address / Address
Postcode / Postcode
Telephone Number / Telephone Number
Email Address / Email Address
Relationship to you / Relationship to you
Is this your current employer Yes/No / Is this your current employer Yes/No
Information on this form may be held on manual or computer systems. We will observe strict confidentiality and disclosures will only be made for payroll, administration, and to provide an overall profile analysis of WorkwithYORK.
PLEASE LET US KNOW WHERE DID YOU HEAR OF WorkwithYORK?WorkwithYORK Website
Council Website
York Press
Local Link
Twitter / Job Fair
From another member of staff
Other (please specify)
......
1
Declarations
Acceptance for work is subject to the following: Enhanced Criminal Records Bureau Disclosure, satisfactory references, evidence of eligibility to work in the UK, appropriate qualification(s) and membership of relevant professional body (if appropriate) and Occupational Health clearance. Please see guidance notes attached for more details. Under these procedures you are required to furnish a statement of any previous convictions, which will be checked by the police.
· Have you ever been dismissed from a post because of misconduct or resigned whilst disciplinary action has been taken against you?YES/NO (if YES please give further details on a separate sheet)
· Please state whether you have, to your knowledge, any family or close relationship with any existing employee of WorkwithYORK, City of York Trading or City of York Council, including councillors or school governors.
YES/NO (if YES please give further details on a separate sheet)
· This work is exempt from the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) order 1986, and therefore all convictions, cautions and bind-overs, including those regarded as “spent”, must be declared.
Please complete the separate sheet entitled “Declaration of Criminal Records, Convictions and Cautions for posts working with children and/or vulnerable adults”
· Are you on List 99, disqualified from work with children, or subject to sanctions imposed by a regulatory body? e.g. the General Social Care Council (GSSC) or the Department for Education Teaching Agency?
YES/NO (if YES please give further details on a separate sheet and sealed in an envelope marked “Confidential”)
· I understand that any appointment is conditional on these declarations and the checks explained above. I also understand that any incorrect, false or misleading information may make this application void. In addition, I am aware, that should this situation occur after I join the employment of WorkwithYORK, I would be liable to disciplinary action that may result in my dismissal and possible referral to the police.
· I declare that all the information contained in every section of this application is true and accurate.
Signature / Date
Declaration of Criminal Records, Convictions and Cautions
For posts working with children and or vulnerable adults
Please answer all the questions and sign the declaration
1. The work for which you are applying is exempt from the provisions of the Rehabilitation of Offenders Act (1974) as it involves working with children (under 18’s) and or vulnerable adults. This means that you must disclose information about any spent or unspent convictions in applying for this post. You must also provide any information about cautions, no matter how long ago they occurred and regardless of whether the offences were committed as an adult or juvenile.2. WorkwithYORK will check through the Disclosure Service provided by the National Criminal Records Bureau. In signing this declaration you will be providing confirmation of your understanding of the provisions and permission to carry out this check, if you are successful at interview.
3. You are also giving permission for any number of past employers to be contacted regarding this application for employment.
4. Having a criminal conviction will not necessarily exclude you from appointment and any information you supply will be treated as confidential and will not necessarily prejudice your application.
5. Please tick the relevant box
1. Do you have a criminal record?
If yes, nature of offence
Date of conviction
Penalty / Yes /
No
2. Have you ever been banned from working with children (up to age 18) or vulnerable adults? / Yes / No3. Have you ever been the subject of any proven/unproven
investigation(s), complaints(s) in relation to your work with children or vulnerable adults, whether in a paid or voluntary capacity or carried out privately? / Yes / No
4. Are you subject to a ban under either the Protection of Children’s Act 1999, Care Standards (Vulnerable Adults) Act 2001; Disqualification from Working with Children Regulations; or serving a Disqualification Order under the Criminal Justice and Court Services Act 2000? / Yes / No
If you answer is yes to any of these questions and you are short listed, the panel will discuss this at interview. You may wish to provide documentation concerning these.
Name
Signed Date
Failure to complete and the signing of this declaration will invalidate your application for this post. Failure to disclose information regarding any of the above and which for other purposes are 'spent' under the provisions of the Act, will normally result in the offer being withdrawn. Dismissal may also happen if we find out any relevant information after we have appointed you.
EQUAL OPPORTUNITIES MONITORING FORM – CONFIDENTIAL
Mr/Mrs/Miss/Ms/Dr/Other
/Surname
/Forenames
Marital Status (please circle)Married / Separated/Divorced / Single / Other
Ethnic Origin (please circle)
Black orBlack British :
Please circle / Caribbean / African / Any other
please specify
White :
Please circle / British / Irish / Any other
please specify
Asian or
Asian British :
Please circle / Indian / Pakistani / Bangladeshi / Any other
please specify
Mixed :
Please circle / White and Black Caribbean / White and Black African / White and Asian / Any other
please specify
Chinese :
Please circle / Chinese / Any other
please specify
Do you consider yourself disabled? (please circle)
YES / NO
SECTION 11. GUIDANCE NOTES AND RECRUITMENT INFORMATION
PLEASE DETATCH THIS SHEET AND RETAIN IT FOR YOUR FUTURE USE
WorkwithYORK supplies 'temporary' workers (also known as relief, sessional or supply staff). There is no obligation for the WorkwithYORK to offer work, and no obligation on the individual to accept work.
Assignments that we may offer temporary staff vary from a few hours to a few months at a time e.g. during the peak season, for several evenings or lunchtimes, for odd days to cover absence or help out in an emergency etc.
COMPLETING YOUR APPLICATION FORM
It is important that you fill in every section of the form as fully and accurately as possible. Our decision on who is suitable will be based on the information you give on your application form.
Before you start:
· Consider the type of work you would like to do and read all the information first to make sure that work through WorkwithYORK on a temporary basis is suitable for you.
· Read the application form carefully before you write anything.
Filling in the Form:
· Please write or type in black ink. (paper applications)
· Please be sure to complete section 9 which allows you to state the type of work you are looking for.
· If you have a copy of your CV, please feel free to attach it to your application form.
· Fill in all parts of the application form. If some parts do not apply to you, put ‘N/A’ (not applicable) in the space provided.
· Use extra sheets if you require more space. Please put your name on each additional sheet and attach as appropriate (paper applications).
· Your application form should be geared to the type of work you would like to be offered.
· Make sure the information you provide is clear, precise and easy to understand.
· Please complete the equal opportunities monitoring form at the back of the application form. The information gathered will be used to monitor the effectiveness of our equality statement and other work related policies.
· If there is a specified closing date please note this and allow time for your application form to reach us. We will not consider application forms we receive after the closing date. However WorkwithYORK is continuously refreshing and adding to the pool of candidates, therefore there is no closing date for the general pool.
Please remember the following:
We want to accept the best candidates into the WorkwithYORK. To do this fairly, everyone who applies must give us relevant information about himself or herself. Where possible, please give examples of how you have used your skills and experience and show successful results where you can.
Criminal Convictions
We do not discriminate against people with criminal records. If you have a criminal record, this does not mean that we will automatically refuse to offer you work. The criminal record information you are required to provide is not used for selection purposes.
If you are invited for interview your criminal record will be discussed with you at interview. The nature and seriousness of any offences, how long ago they occurred and their relevance to the duties of the posts for which you are applying will be taken into account, before a decision is made as to whether your criminal record information makes you unsuitable for particular assignments.
Under the Rehabilitation of Offenders Act 1974 (ROA) as amended, you only have to declare unspent convictions. If the post is not exempt, such as posts involving working with children or vulnerable adults, then you will be required to complete a separate form, which will come with your application form.
If you do not provide the information on your application form we may withdraw any offer of work. Failure to disclose information about convictions which for other purposes are 'spent' under the provisions of the Act, will normally result in acceptance to WorkwithYORK being withdrawn. Withdrawal from any work assignment may also happen if we find out any relevant information after we have offered and you have accepted work.