Gloucester City Council
Part A: Personal Details and Equalities
Monitoring Data
The Council is committed to developing fair and inclusive employment policies and to secure a workforce that reflects the community it serves. To ensure there is no unlawful discrimination, we need to monitor the recruitment process.
The information you supply in Part A of the form will be kept separate from the application form before candidates are selected for interview.
PERSONAL DETAILS (Please print if submitting hard copy. You are advised to complete all sections of this form)
National Insurance Number: Date of Birth:
Title (Mr/Mrs/Ms/Miss/Dr etc.):
First names: Last name:
Address:
Post code:
Telephone numbers: (daytime): (home/mobile)
Email:
Are you related to a Councillor or any employee of Gloucester City Council?
REHABILITATION OF OFFENDERS ACT 1974
Have you any convictions not spent under the Rehabilitation of Offenders Act?
ADVERTISING
Where did you see this job advertised?
PREFERRED WORKING ARRANGEMENTS
Full-time / Annualised Hours / Part-time / Job share / Term time onlyINTERVIEW ARRANGEMENTS
Do you need any arrangements made for the interview e.g. to accommodate disability?
MONITORING INFORMATION
Disability
Do you consider you have a disability or impairment that needs to be taken into consideration in order to ensure that you have equal and fair access to employment?
Yes No Decline to identify
Age
Please give your age
Gender
Please indicate your gender
Male Female
Ethnic Origin
These are the categories used in the 2001 census. Choose a section and then indicate your category
White / Black or Black British / Asian or Asian BritishBritish
Irish
Other White
Background / Caribbean
African
Other Black
Background / Indian
Pakistani
Bangladeshi
Other Asian
Background
Mixed / Chinese or Other Ethnic Group
White & Black Caribbean
White & Black African
White & Asian
Other Mixed Background / Chinese
Other Ethnic Group
If you have indicated ‘Other……..’, please state your ethnicity…………………………
The Council recognises that sexual orientation and religion or belief are very personal and sensitive issues. However, in order to determine equality in recruitment and selection and whether the Council has a representative workforce, we need to monitor these areas.
Sexual Orientation
Bisexual Gay woman / lesbian Gay man
Heterosexual / straight Other (if you feel categories unsuitable)
Decline to identify
Religion or Belief
Buddhist Christian Hindu
Jewish Muslim Sikh
Other religion No religion
Decline to identify
I declare that the information on this form is correct and that I agree to it being held and processed in accordance with the data protection Act 1998.
In submitting this form you are agreeing that the information on this form is correct, and to it being held and processed in accordance with the data protection Act 1998.
Gloucester City Council
Part B: Application Form
Post applying for: Post no
Service Unit (if known): Closing date
Do you have a full valid license to drive vehicles in the UK?
QUALIFICATIONSAcademic/professional qualifications in date order (most recent first)
Subject / Qualification /
Grade
Proof of professional qualifications will be required at interviewCurrent membership of relevant professional or technical bodies and membership status
CURRENT OR LAST JOB
Name of employer______
Address______
Job Title______Period of Notice______
Dates from ______To______
Brief description of duties / responsibilities
Reason for leaving
PREVIOUS JOBS (in date order, most recent job first)
Please demonstrate how you meet each of the essential and desirable criteria in the person specification. Provide examples of your experience and training (voluntary, work-related or personal) to support your statements. Please do not attach a C.V.
If you are not in employment, please give a previous employer. Please ensure that your referees are in a position to respond promptly. If you believe there may be difficulty in obtaining references you should discuss the matter with the contact in the job advertisement.
PRESENT/LAST EMPLOYER
Name
Address
Email:
Post Code: Tel. No: / OTHER REFEREE
Name
Address
Email:
Post Code: Tel. No:
May we contact referees prior to interview? YES NO
Please note we will ask referees to confirm sickness levels
Failure to disclose relevant information requested in this application form will disqualify a candidate and discovery of erroneous information after appointment may lead to dismissal.
This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes. For further information see http://www.gloucester.gov.uk/council/data-protection-and-foia/Pages/Fair-Processing-Notices.aspx
Applications will only be accepted from candidates eligible to work in the UK (please see enclosed information)
Canvassing Councillors or any employee, either directly or indirectly, will disqualify you.
I declare that the information on this form is correct and that I agree to it being held and processed in accordance with the data protection Act 1998.
In submitting this form you are agreeing that the information on this form is correct, and to it being held and processed in accordance with the data protection Act 1998.