Job Ref: / FUT / Job Title:
Location: / Salary:
Hours per week:
Please note: This sheet and the Equal Opportunities Monitoring Form will be detached from the rest of your application form on receipt and will not be considered during the selection process.
* Compulsory Fields
1. Personal DetailsTitle (Mr/Mrs/Miss/Ms/Dr):*
First Name(s):*
Surname:*
National Insurance Number (NI):*
Home Address:*
Postcode:*
Daytime Telephone No:*
Evening Telephone No:*
Mobile Number:
Email address:
Equal Opportunities Monitoring Form
Futures Advice Skills and Employment are committed to the elimination of all forms of unjustifiable discrimination. We are actively pursuing equalities of opportunity for all and are seeking to ensure that all prospective and existing employees are treated fairly. In working towards the success of this policy, we ask all internal and external applicants for promotion or recruitment to complete the questions below.
This information will be treated as completely confidential and will be used for monitoring purposes only. This information will be detached from the application form on receipt and will not be considered during the selection process.
Gender:* / Male / Female / Date of Birth*(DD/MM/YY)
Which do you consider to be your ethnic origin:*
Black/Black British / Black African / Black Caribbean / Other Black Background
Dual Heritage / White and Asian / White and Black African / White and Black Caribbean / Any other Dual Heritage
White / White British / White Irish / Other White Background / White Not Known
Other / Other (Please State)
As a “positive about disability people employer” we undertake to interview disabled people who meet the minimum essential criteria as detailed on the person specification. For these purposes, disability is defined by the Equality Act 2012. The Act, defines disability if a person:
· has a physical or mental impairment
· the impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities
· for the purposes of the Act, these words have the following meaning:
a) ‘substantial’ means more than minor or trivial
b) ‘long-term’ means that the effect of the impairment has lasted or is likely to last for at least twelve months.
Do you consider yourself to have a disability?* / YES / NO
If yes, please state the nature of your disability:
If you need any particular arrangements to be made for interview (eg access, signer, interpreter), please specify:
Where did you hear about this vacancy?
Universal Job Match/DirectGov / This is.../Jobsite / Nottingham Jobs Fund
Futures Careers Centre / Twitter / Vacancy Email Alerts
Other (please give details):
Job Ref: / FUT / Job Title:
Location: / Salary:
Hours per week:
Driving qualifications
Do you hold a current, valid driving licence?* / YES / NO
Do you have regular use of a vehicle?* / YES / NO
Entitlement to work in the UK
Are you a UK or EU/EEA Citizen?* (if not, it is possible that you may not be eligible to work in the UK without a work permit/visa). / YES / NO
Please indicate if you will require a work permit:* / YES / NO
To comply with the Asylum and Immigration Act 1996 all prospective employees will be asked to supply evidence of eligibility to work in the UK. We will ask to see an appropriate official document. DO NOT SEND THESE NOW. Further information will be sent to you if you are selected for interview.
Will you be aged 65 or over within six months of closing date?* / YES / NO
2. Paid Employment History
Current Employer: / Employer’s address:
Telephone Number: / Notice Required:
Position held: / Main areas of responsibility:
Start date:
Salary:
Reason for applying for this post:
Previous Paid Employment
Start with the most recent employment providing all details as requested
Previous Job One
Company Name: / Position held:
Address of Employer: / Salary:
Start date:
End date:
Reason for leaving employment: / Main areas of responsibility:
Previous Job Two
Company Name: / Position held:
Address of Employer: / Salary:
Start date:
End date:
Reason for leaving employment: / Main areas of responsibility:
Previous Job Three
Company Name: / Position held:
Address of Employer: / Salary:
Start date:
End date:
Reason for leaving employment: / Main areas of responsibility:
Previous Job Four
Company Name: / Position held:
Address of Employer: / Salary:
Start date:
End date:
Reason for leaving employment: / Main areas of responsibility:
Previous Job Five
Company Name: / Position held:
Address of Employer: / Salary:
Start date:
End date:
Reason for leaving employment: / Main areas of responsibility:
3. Other previous jobs/voluntary work/gaps in employment
Please provide information about any other previous jobs/voluntary work/gaps in employment:
4. Education/Training/Development
Please state all qualifications obtained. For each period at an educational establishment please fill in the name of the establishment, the qualifications you obtained and the date these qualifications were obtained. eg. Redhill School, Nottingham – French GCSE grade C, Maths GCSE grade A, History GCSE grade D etc – 06/2002
Please start a new educational establishment entry for every different establishment or different period of study.
If you are selected for interview you will need to evidence stated qualifications. If you have an overseas qualification, please include century and explain level.
Name of School/College/
University Provider (From Secondary Education onwards) / Qualifications including grades / Date obtained (Month/Year)
5. Knowledge and Experience of Information Technology
All Futures Staff are required to use computerised systems in their work. Please indicate your experience and the systems you are familiar with.
It is preferred that this section is word processed.*
Relevant training and personal development (State who provided training, duration and dates) Examples could include: short courses, skills training, external awards/activates, etc.
Current Membership of Professional Organisations (grades achieved):
6. Supporting Statement
Please evidence how you meet the application requirements of the person specification, taking each criteria in turn.
Please continue on a separate sheet if required, your supporting statement should be a maximum of two sides of A4 paper.*
7. Medical Record
Prior to formal appointment candidates will be required to complete a confidential statement of medical history and may be required to undergo a medical examination.
8. Disclosure
Safeguarding: Disclosure of criminal background
Disclosure will apply to all posts that fall under the Disclosure and Barring Service (DBS) definition of ‘Regulated Activity’. The successful candidate will be required to submit an application to the DBS for Disclosure for Criminal Conviction(s). If the Company finds anything in that record which might be considered prejudicial to his/her working within the regulated activity then the appointment may not be confirmed.
9. Reference Details
You must provide at least two referees covering at least the last three years of your employment. Please give the names and address of the referees below (not relatives, friends or people with whom you live). If you have just left/are leaving education please provide details of a relevant tutor. If in employment you must quote your present employer, giving the name of your Line Manager. We reserve the right to ask you for further referees if necessary. In addition to information on ability and performance we will be seeking information on sickness absence. With your permission references will be requested if you are selected as the preferred candidate following interviews.
Ref One Name:* / Ref Two Name:*
Organisation:* / Organisation:*
Address:* / Address:*
Postcode:* / Postcode:*
Tel. No:* / Tel. No:*
Email Address:* / Email Address:*
Position held:* / Position held:*
Ref Three Name:* / Ref Four Name:*
Organisation:* / Organisation:*
Address:* / Address:*
Postcode:* / Postcode:*
Tel. No:* / Tel. No:*
Email Address:* / Email Address:*
Position held:* / Position held:*
10. Declaration
I declare that this information is correct and agree that this would form part of the basis of my engagement should my application be successful. The information provided will be processed and stored for Company use in line with the Data Protection Act 1988. I authorise Nottingham and Nottinghamshire Futures to check the information supplied. I understand that providing misleading or false information/qualifications will disqualify me from appointment or if appointed may lead to dismissal.
Sign here to indicate you agree with the declaration statement above:*
Signature (Please print name): / Date:
Please note that your application will not be considered without this declaration.
Document Name: Futures Application Form Date: 14th November 2014
Author: Human Resources Version: 7
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