job application form
BirminghamCityCounciliscommittedtoequalopportunitiesinemploymentand wepositivelywelcomeyourapplicationirrespectiveofyourgender,race, disability,colour,ethnicornationalorigin,nationality,sexuality,genderidentity,
maritalstatus,responsibilityfordependants,religion,tradeunionactivityandage.
Pleasecompleteallsectionsontheform.Ifanysectiondoesnotapplyto you,enternotapplicable(n/a).ItisimportantthatyourefertotheGuidance Notesbeforecompletingthisform.Electronicversionsofthisformare availableat
Thisformisalsoavailableinlargeprint,Brailleoronaudiotapeonrequest.
1. Vacancy DetailsThissectionmustbecompleted
FOROFFICEUSE
Jobrefno: IT
Datesentout: Datereturned: Applicationno: ClosingDate:
Job title:Directorate:ServiceArea:
2. Personal Details
First name(s):Last name:Title:e.g.(Mr,Mrs,Ms):
Former name(s):Date of Birth://
Address:
Postcode:
Daytime tel no:Evening tel no:
Mobiletelno:Email:
Please indicate if you are happy to receive correspondence via your email address e.g. invite to interview letter:
YesNo
National Insurance Number, if you have one
Do you havethe Right to Work in theUK? YesNo
Please note: original identification documents verifyingyour right towork inthe UKwill be requested, checked and a photocopywill be taken. If your application is successful andyou commenceemployment the copyofyour identification documentswill be retained on fileunder the regulations governed bythe Immigration, Asylumand Nationality Act.
Current driving licence (if this isarequirement of thisjob):YesNo
If YES, type of licence
3. General Information4. Arrangements for interview
a) Are you related to a Councillor or employee of
Birmingham City Council?YesNo
If yes, pleaseprovide details:
If you have adisability, are there any arrangementswhich we can makefor you if you are called for an interview and/orwork based exercise? Yes No
Name:If yes, pleasespecify, (e.g. ground floorvenue, sign language interpreter, audiotapes etc).
Position:
Relationship:
Directorate:
b) Do you wish to job share the job youare applying for?YesNo
To / From / SecondarySchool/ / Examinationstaken / Results / Datemth / yr / mth / yr / College/Universityetc / ortobetaken / grades / gained
6. Training Pleaselistanycourse(s)whichyouhaveundertakenwhicharerelevanttothejoband/or specifiedonthepersonspecification.
Year / Organisingbody / Coursetitle / LengthPleasecontinue on a separate sheet if necessary.
Nameoforganisation / Typeofmembership / Dateofmembership8. Past Employment & Experience(ifany)includevoluntaryorotherrelevantexperience.
To / From / Employer / JobTitle / Reasonforchangemth / yr / mth / yr
Pleasecontinue on a separate sheet if necessary.
Job title:Employer:
Salary:
DateStarted:Date left (if applicable):
Address:
Postcode:
Reason(s) for leaving (if applicable):
10. Ill Health Retirement/Dismissal
Have you ever taken ill health retirementfrom Birmingham City Council or been dismissed for some other reason?
YesNo
Ifyes, please give the date and department/directorate:
11. References Pleasegivedetailsoftworefereesoneofwhichmustbeyourcurrentormostrecentline manager/supervisor,orotherpersondesignatedwithintheorganisationtoprovidereferences.
Pleaseputacrossintheappropriatebox(es)belowifyoudonotwishustotakeupareferencewithout yourconsent.
Name:
Address:
Postcode:
Tel no:Email:
Job title:Relationship to you:
Ifthis refereeknows you byanother name please give that name:
Name:
Address:
Postcode:
Tel no:Email:
Job title:Relationship to you:
Ifthis refereeknows you byanother name please give that name:
Please note some jobs may require a Criminal Records Bureau check, further information regarding this will be contained in the application pack, if applicable.
12. OtherinformationinSupportofyourApplication
Inorderforus todecidewhethertocallyouforinterview,itisessentialthatyouprovideuswithsufficientdetailsofany experienceandskillswhichdemonstratehowyoumeettherequirementsofthisjob,assetoutintheperson specification.Pleasecontinueopposite.Youmayalsocontinueonaseparatesheet(s)ifyouwish. Youshould ensurethatanyadditionalsheetsareattachedsecurelyandincludeyournameandjobreferencenumberIjobtitle.
Itisimportantthatyourefertothe'GuidaneeNotes'whencompleting thissection.
13. Data Protection Act 1998 - Consent and Certification of Details
The information detailed inthis application form maybeused by Birmingham CityCouncil in the monitoringand progression ofits employment policies and practices,and in particular its EqualOpportunitiesin Employment Policy. This monitoring is forstatistical purposes only and you will not beidentifiable from thisprocess.However,your personal details contained in the application form maybe used in the prevention and detectionof fraud.Where this occurs you will be identifiable.The informationmay be disclosed tothe followingthird parties:
•Survey and research organisations (formonitoring purposes only).
•Local Government Authorities
•Central Government Authorities
•Organisations that handle or investigatethe proper use of public funds
•Law Enforcement Authorities
Application forms of unsuccessfulcandidateswill bedestroyed after six months following an appointment to the job. Giving false information will result in your applicationnot being pursued or your contract being terminated if you have already beenappointment to the job.
I, (print name):
Consent to Birmingham CityCouncil recording and processing the information detailed in this application form.I understand that this information may be used by the CityCouncil in pursuance of its business purposes and my consent is conditional upon the City Councilcomplying with theirobligations under theDataProtection Act 1998.
I also confirmthat the information contained in this application formis correct. Signature:Date:
Ifyou are makingyour application in Braille or on audio tapeyou must declare thatyouhave read and understoodthis section and that the informationyou have given is true andcorrect at the time of completion. You mayalso be required to sign a declaration tothis effect at a later date.
Application forms not fullycompleted maybe refused.
Recruitment Monitoring
Name:Gender
Job title:I am:FemaleMale
Job ref no:Date of Birth:Age:
To help us monitor our Equal Opportunities in Employment Policy pleasetick orcomplete the followingboxes as appropriate:
Ethnic Origin
Choose onesection from(A) to (E) thentick the appropriate box to indicateyour culturalbackground. These are based on the 2001 Censuswith additional categories included.
A White
BritishAlbanian/KosovanRoma
Disability
The DisabilityDiscrimination Act 1995 defines a person as having a disability if he/she has a physical or mental impairment which has asubstantial andlong term adverse effect on his/her ability to carry out normal day to day activities.
Do you havea disability as defined above?YesNo
If all ofthe above does not apply to you, however, you consideryourselftohaveadisability, please tick here.
Employment Status
IrishBosnianAre you currently employed by Birmingham City Council?
YesNo
Any other White background please write in below:If yes, pleasestate if you are employedon a temporary,
casual or permanent basis:
B MixedAre you currently unemployed?YesNo
White and Black - Caribbean
White and Asian
White and Black - AfricanWhat isyoursexual orientation?
Asian and Black
Bisexual
Any other Mixed background please write in below:Gay Man Lesbian or Gay Heterosexual/Straight
C Asian or Asian BritishOther
Not Disclosed
IndianKashmiriPakistaniBangladeshi
Any other Asian background please write in below:
Religion
D Black or Black BritishChristian -Catholic
Buddhist
CaribbeanAfricanHindu
Jewish
Any other Black background please write in below:Muslim
Sikh
No religion
E Chinese orother ethnicgroupOther - please specify:
ChineseArabAfghan
KurdishVietnamese
Any other pleasewrite in below:
Job Advertisement
How did you first find out about this job?Please specify the sourceor publication.
Jobs4U jobs bulletin
Birmingham City CouncilWebsite
JobsgopublicWebsite
Website, other (please specify),
Professional Journal(please specify),
Birmingham Evening Mail
Other Newspaper(please specify),
Radio (pleasespecify),
Word of Mouth
Careers/open day (pleasespecify),
Jobcentre Plus
Search Consultant
Other (pleasespecify),