HENBURY SCHOOL – An Independent Academy

CONFIDENTIAL APPLICATION FORMFOR

NON-TEACHING POST

Henbury Schoolis committed to safeguarding the welfare of children and expect all staff to share this commitment. An enhanced DBS check is required for the successful applicant.

Post for which you wish to be considered:

Where did you see the advert?

1.Personal Details:

Title: / Surname:
Forename:
Address:
Daytime Tel. No.: / Evening Tel. No.:
Email: / Mobile No.:
N.I. No.: / Are you in receipt of an Occupational Pension: YES / NO
Will you need a work permit if appointed to this post? YES / NO
Interview
Do you require any special arrangements for interview?

Please note that all candidates are treated equally regardless of their age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

2.Education / Training / Qualifications:

School / Subject / Grade / Date Obtained

3.Award Bearing Post Secondary Education:

College / University / Course / Dates

4.Employment:

Please provide details of your full employment profile, commencing with your current position.

Title of Post / Organisation / Salary including allowances / Dates / Reason for leaving
How much notice do you need to give?
Gaps in employment or training (Please indicate and explain any gaps since leaving secondary education)
Date from / Date to / Reason for gap

Please continue on a separate sheet if necessary

5.Relevant Courses attended during the last three years:

Course / Organised by / Dates / Duration

6.Additional Information:

Please provide a personal statement explaining how your experience meets the requirements of this post, giving specific examples. Please add any further information which you feel supports your application.

Please continue on a separate sheet if necessary

7.References:

Please give the name, address and status of two persons who can support your application and who have agreed to their names being used. Unless there are good reasons to the contrary, one of the referees should represent your present employer. If you are shortlisted references will be taken up automatically prior to interview.

Name, Status and Address:
Tel:
Email:
Fax:
Tel:
Email:
Fax:
If shortlisted for interview, please give any
days/dates when you would not be available:

8.Protection of Children:

Disclosure of criminal background is required of those with substantial access to children.

All information you provide will be treated as confidential and managed in accordance with relevant data protection legislation and guidance. You have a right of access to information held on you under the Data Protection Act 1998.

Have you ever been known to any children’s services department or to the police as being a risk or potential risk to children? / Yes/No
If yes, please provide further information:
Have you been the subject of any disciplinary investigation and/or sanction by any organisation due to concerns about your behaviour towards children? / Yes/No
If yes, please provide further information:
Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amended) 2013? If yes, please provide further information: / Yes/No
Criminal Convictions or Cautions
Date / Offence / Sentence

By signing this application form you are consenting to the Academyundertaking a DBS check should you be offered a position.

9.Submit

I declare that the information I have given on this form and additions is correct. I understand that any offer of employment will be subject to satisfactory references and medical examination. Any misleading statement or deliberate omission will disqualify my application and lead to instant dismissal.

I consent to the necessary enquiries and checks being undertaken by the Academy in order to confirm that the information I have included in this application form is correct and to verify the authenticity of my qualifications.

I understand that if I am successful in my application any information contained in this form together with any obtained in relation to it, will be retained by the Academy during the course of my employment and for a reasonable time after the employment ends (pursuant to the Data Protection Act 1998)

I confirm I have no objection to the Academy making an application to the Disclosure & Barring Service for information about any previous convictions, which I may or may not have on record and I confirm that I will sign the necessary application form giving an authority to make this search (pursuant to the Police Act 1997 as amended by the Protection of Children Act 1999).

I declare that I am not disqualified from working with children (pursuant to Criminal Justice and Court Services Act 2000).

Declaration

I accept the data protection terms above anddeclare that the information I have given on this form and additions is correct.

Signed: / Date:

Please return completed Application and Monitoring Formto the Personnel Officer by email to:

or by post to:

Mrs Clare Bradford

Henbury School

Henbury

Bristol BS10 7QH

Unsigned applications will require to be signed prior to appointment

JOB APPLICATION MONITORING RECORD SHEET
We are committed to equality of opportunity in employment. In order to monitor how far we are achieving this we need certain information from you at the point at which you apply for a vacancy. This form will be kept separate from the selection process and will only be used for equality monitoring in order to ensure equal treatment of all.
Position applied for......
  1. How would you describe your nationality and/or ethnicity (please tick)?
White: / Black or Black British: / Chinese or other ethnic group:
British — English, Scottish or Welsh / / Caribbean / / Chinese /
Irish / / African / / Any other ethnic group /
Any other white background / / Any other Black background /
Mixed race: / / Asian or Asian British: /
White and Black Caribbean / / Indian /
White and Black African / / Pakistani /
White and Asian / / Bangladeshi /
Any other mixed background / / Any other Asian background /
  1. How would you describe your sexual orientation (please tick)?
HeterosexualBisexualLesbian
GayPrefer not to say
  1. How would you describe your religion (please tick)?
My religion is:...... I am not religious Prefer not to say
  1. The Equality Act 2010 defines a disability as a "physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is likely to last, over 12 months. This also includes any diagnosis of Cancer or HIV.
Do you consider yourself to have a disability (please tick)?
YesNoI used to have a disability but have now recoveredDon’t know
Do you require special adjustments for interview? Yes No
Please note we are an Equal Opportunity employer and no applicant will be unlawfully discriminated against.

AppNonTeaching