South West Heritage Trust

Application Form for post of Learning Officer

Please type or write in black ink as this form may be photocopied. Please complete your application form as fully and concisely as possible based on the information we have provided, with reference to the person specification in particular.

Please return this form by email to:
Application for the post of / Learning Officer
Service Area / Museums – Somerset Rural Life Museum
Closing Date / Thursday 2 February 2017 at 5.00 pm
How did you hear about this job? (Name of publication if advertised)

1Personal details (BLOCK CAPITALS)

Full name
Address
Postcode
Tel day: / Tel eve:
Mobile: / Email:

2References

Please give the names and addresses of two referees, who are not related to you. One of these must be your current or most recent employer. Please indicate if you are happy for us to take up references prior to the interview date.

1st Referee2nd Referee

Name / Name
Occupation / Occupation
Address / Address
Postcode / Postcode
Telephone / Telephone
Email / Email
In what capacity do you know this referee? / In what capacity do you know this referee?
May we contact this referee before interview? / YES / NO
(delete as appropriate) / May we contact this referee before interview? / YES / NO
(delete as appropriate)

3Current or most recent employment

Employer’s name and address:
Job title
Dates of employment / Salary
Notice required or date left / Part-time or full-time
(please give hours)
Position held and summary of duties
Please explain why you are applying for this post at this time

4Previous employment

Please start with the most recent job, before the one detailed above. Please include any gaps in employment or volunteer work. Continue on a separate sheet if necessary.

Employer’s name and address / Date from / Date to / Position held and summary of duties / Reason for leaving

5Education, professional qualifications, other relevant experience

Education (from secondary level onwards)

Schools, colleges, universities / Dates / Qualifications gained
(including subjects and grades)

Professional qualifications

Professional body / Qualification / Date obtained

Relevant training

Please give details of any other qualifications, training or experience which you consider to be relevant to your application, including those gained outside the workplace.

6Supporting statement

Please explain why you are applying for this post and how your skills, experience and achievements make you suitable for this job. Please refer to the information enclosed with this form and, in particular, the criteria in the ‘person specification’ on the job description. (No more than 2 sides of A4)

7Supplementary Information

If specified in the Job Description, are you willing and able to travel to meet the requirements of this job? / YES / NO
(delete as necessary)
Please provide details of any current motoring convictions, disqualifications or penalty points, with dates and reasons and/or any difficulties you foresee concerning travel:
Positive About Disability: We welcome applications from people with disabilities. Wherever possible we will make reasonable adjustments to enable a person with a disability to access the application and appointment process fairly.
Do you consider yourself to have a disability? / YES / NO
(delete as necessary)
If “yes” and you are offered an interview, would you welcome a pre-interview discussion to identify any particular needs that you may have? / YES / NO
(delete as necessary)
Are you eligible to work in the UK? / YES / NO
(delete as necessary)
Disclosure of Criminal Offences: The Rehabilitation of Offenders Act 1974 gives individuals the right not to disclose details of old offences which are seen as ‘spent’
Please give details, including dates and places, of pending prosecutions and any convictions, cautions and bind-overs since the age of 17 years, that are not ‘spent’:
If the information sent to you highlights that the post requires a Disclosure Certificate, the Rehabilitation of Offenders Act does not apply in this case. Therefore, please give details, including dates and places, of any ‘spent’ convictions, cautions and bind-overs. Please also detail if you are on List 99, the PoCA List, disqualified from working with children or vulnerable adults or subject to sanctions imposed by a regulatory body such as the General Teaching Council or General Social Care Council:

8Availability and interview arrangements

Please note interviews will be held on Thursday 16 February 2017. If this date is inconvenient, please advise us in this section.

Please sign and date this form

I declare that the information I have given in this application is, to the best of my knowledge and belief, true and correct. I understand that any job offer made on the basis of untrue or misleading information may be withdrawn or my employment terminated.

Signature ______Date ______

Please return the completed form by email to

South West Heritage Trust

Equal Opportunities Monitoring Form

Statement

The South West Heritage Trust is committed to equality of opportunity for all employees and job applicants. We seek the best candidates who most fully fit the qualities identified in the Person Specification and can fulfil the Job Description. This is judged objectively and based on personal merit.

All information given in the following equal opportunities monitoring form is given in strictest confidence and will not be made available to the short-listing or interviewing panel. The data collected is for monitoring purposes only. Completion of the information is not mandatory but will help us to monitor our equal opportunities policy.

Equal Opportunities Monitoring Form

Treated in the strictest confidence

Post Applied for / Name
Date of birth
Are you?
Please tick one of the appropriate boxes against each the questions below
Gender
1. Female / 2. Male / 3. Prefer not to say
Sexual Orientation
1. Bisexual / 2. Gay /Lesbian / 3. Heterosexual / 4. Prefer not to say
Transgender
1. Yes / 2. No / 3. Prefer not to say
How would you describe your ethnic origin?
a)White / Z. English/Welsh/Scottish/North Irish/British / K. Gypsy or Irish Traveller
D. Irish / Q. Any other White Background
b)Mixed/Multiple Ethnic / H. White and Black Caribbean / I. White and Black African
J. White and Asian / S. Any other mixed background
c)Asian or Asian British / E. Indian / X. Pakistani / G. Bangladeshi
P. Chinese / Y. Any other Asian background
d)Black/African /Caribbean/ Black British / T. Caribbean / V. African / R. Any other black background
e)Other ethnic group / A. Arab / B. Any other group
f)Prefer not to say
Do you consider yourself to have a disability or impairment?
Under the Equalities Act 2010, a person with a disability is defined as having a physical or mental impairment which has a substantial, long term effect on their ability to carry out normal day to day activities.
YesNoPrefer not to say
If yes, please indicate the nature of your disability.
Physical Impairment / Mental Impairment / Mobility Impairment
Visual Impairment / Hearing Impairment / Learning Disability
More than one Impairment / Other / Prefer not to say
Which Religious Group do you belong to?
0Buddhist / 1 Christian / 2 Hindu / 3 Jewish / 4 Muslim
8 Sikh / 5No Religion / 6 Any other religion / 7 Prefer not to say
Are you currently employed?
YesNo
Is your main contract?
Permanent / Fixed Term / Casual / Relief

Thank you for your cooperation.

Please return the completed questionnaire with your application form.