Piper Hill High School

PIPER HILL HIGH SCHOOL

Position applying for:Cleaner / Lunchtime Support Assistant

The governing body is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment.

Please ensure that you complete all sections of Part 1 and Part 2 of the application. Please note that providing false information will result in the application being rejected, or withdrawal of any offer of employment, or summary dismissal if you are in post, and possible referral to the police. Please note that checks may be carried out to verify the contents of your application form. Please complete the form in black ink. CV’s are not accepted.

PART 1 : INFORMATION FOR SHORTLISTING AND INTERVIEWING

INITIALS: SURNAME OR FAMILY NAME:
Application for the position of:
Closing Date:
Full -Time: Part - Time: ▢ Job Share: ▢

1. Details of Current Employment

Are you presently employed? Yes No
Present Post (or most recent. Please enclose a copy of the job description, if possible.)
At:
Address:
Telephone No.:
Permanent: Temporary: Full time: Part time: Job Share:
Date of Appointment: Reason for Leaving:
Notice Required:
Description of key duties/responsibilities:
Please provide the following information relating to present salary and scale:
Salary scale ( where applicable ): Additional Allowances:
Annual Salary £

Piper Hill Support Staff ApplicationPart of the Prospere Learning Trust

1. CONTINUING PROFESSIONAL DEVELOPMENT/TRAINING (appropriate to the Job)

Please list any course that you have completed and/or any professional development that you consider relevant to the post

Course title

/ Provider / Dates
From and To / Duration
eg: number of days / Awards (if any)

Piper Hill Support Staff ApplicationPart of the Prospere Learning Trust

Please complete as applicable:

1. SECONDARY, FURTHER AND HIGHER EDUCATION

Dates

From

To

/ School, College, University or Establishment / Examinations taken or being taken or any other qualification obtained / Full or Part Time / Exam result and grade

1. OTHER EMPLOYMENT / WORK EXPERIENCE

Please provide details in chronological order (from oldest to most recent )of previous employment, any experience/activities.
Eg: previous employment experience, commercial experience, youth work, and voluntary work.
Details and nature of work/activity / Name of employer / Period of service
From and to / Full time/Part time
FT/PT / Reason for Leaving

1. OTHER

If there are any periods of time that have not been accounted for in your application, for instance, periods spent raising a family or of extended travel, please give details of them here with dates. The information provided in this form must provide a complete employment history ( both paid and unpaid ) – please ensure that there are no gaps in the history of your education, employment and other experience. Failure to provide a full account may lead to your application being rejected.
Period
From and to / Details and nature of work/activity

1. FURTHER SUPPORTING STATEMENT

Using the Person Specification that you have been sent with your application pack, please demonstrate using examples your suitability for the position you are applying for.
Please include your reasons for applying and interest in this position.

1. REFERENCES: It is expected that those currently employed in a school will name their present or most recent Headteacher as their first referee. University leavers should name their course tutor. One referee must be your current or last employer.

References will be taken up for all shortlisted candidates before interview so that any discrepancies may be checked.
1st Referee (present or most recent Headteacher)
Name:
Address:
Email address:
Capacity in which known: / 2nd Referee
Name:
Address:
Email address:
Capacity in which known:

NOTE: Where necessary, previous employers who have not been named as referees may be contacted in order to clarify any anomalies or discrepancies. Two referees from the same organisation will not be accepted.

Both referees need to be suitably qualified to comment on your ability to meet the Person

Specification and Job Description.

PART 2

This section will be separated from Part 1 on receipt. Relevant contents may be verified prior to shortlisting but will not then be used for selection purposes.

1. PERSONAL DETAILS:

First Name(s): Last Name: Title:
Any former name(s):
Permanent Address:
Post code: (Please do not omit your Post Code)
Telephone numbers:
Home: Mobile: Work:
Email address:
How would you prefer to be contacted:
Where did you see this vacancy advertised?
Date of birth:
National Insurance:

1. DISCLOSURE INFORMATION

Have you ever been barred or restricted from working with children or been subject to a child protection investigation? YES NO
If yes please give details under confidential cover:
Do you have a current full driving licence? YES NO
Are you subject to any legal restrictions in respect of your employment in the UK? YES NO
If yes please give details.
Do you require a work permit? YES NO
Please give details separately
Are you (or your spouse/civil partner/partner) related by marriage, blood or as a co-habitee to any member of the Governing Body / Academy Trust Company or any current employees of the Governing Body / Academy Trust Company?
Yes: No:
If yes, please state their name and your relationship
Name: Relationship:
Are there any special arrangements which we can make for you if you are called for an interview and/or work based assessment? YES NO
If yes please specify (e.g ground floor venue, sign language, interpreter)

Disabled Applicants

If you are successfully appointed, every effort will be made to supply aids or equipment where required to enable you to carry out the full duties of the job. If you feel that due to the nature of your impairment, you may not be able to do a certain aspect of the job then the panel will give full consideration to redesigning the job. If you wish to bring such a matter to the panel’s attention at this stage, please do so in the space below.

Data Protection Act

All documents associated with Recruitment and Selection will be stored for a period of 6 months.

Declaration

Public funds must be protected and therefore the information you have provided on your form may be used to prevent and detect fraud. The information may also be shared, for this purpose, with other organisations, which handle public funds.

I confirm that to the best of my knowledge the information I have provided in this application (including home address and self-declaration) is correct and true. I realise that if it is found that I have deliberately given false or misleading information I am liable to be disqualified from further consideration or, if appointed, to be dismissed immediately and without notice.

Any offer of employment will be subject to satisfactory pre-employment medical clearance, DBS checks, two satisfactory references and documentary evidence showing your entitlement to work in the UK.

Signature:Print name:

Date:

Piper Hill Support Staff ApplicationPart of the Prospere Learning Trust

INTENTIONALLY LEFT BLANK

Piper Hill Support Staff ApplicationPart of the Prospere Learning Trust

PART 3

Equal Opportunities Monitoring Form

The information on this form will be treated in the strictest confidence. The results will be used to produce overall statistics about recruitment and selection.

Gender
What is your gender?
Female: Male: Prefer not to say:
Age
What is your age?
Under 16: 16 – 25 years:
26 – 39 years: 40 – 64 years:
65 – 74 years: 75+ years:
Prefer not to say:
Ethnic Origin
How would you describe your ethnic origin?
Bangladeshi 20
Chinese 30
East African Asian 35
Indian 40
Kashmiri 37
Pakistani 45
Vietnamese 55
Other Asian, please specify: 52

Black British 25
Caribbean 15
Somali 18
Other African 10
Middle Eastern 50
Other black, please specify: 60

White and black Caribbean 65
White and black African 70
White and Asian 75
Other mixed origin, please specify 80

Irish 85
White British 90
Other white, please specify: 95
Prefer not to say:
/ Disability
Manchester City Council adopts the Social Model of Disability. This means that it is social and environmental factors, rather than medical conditions or impairments, which create disabling barriers.
Do you consider yourself to be a disabled person under the social model ?
- Yes - No - Prefer not to say
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Sexual Orientation
How would you describe your sexual orientation?
Bisexual
Gay
Lesbian
Heterosexual / straight
Other
Prefer not to say
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Print Name :
Signature:
Date:

Piper Hill Support Staff ApplicationPart of the Prospere Learning Trust