Position:Reference:

Title: / Surname: / Forenames:
Home telephone: / Address for correspondence:
Mobile telephone:
Work telephone:
E-mail address:
D.O.B:
a. Are there any restrictions on you taking up employment in the UK? / Yes / No
If yes, please specify:
b. If you are related to or acquainted with an employee within the CfBT Group of Companies (give details, name and nature of the relationship):
c. Please only complete the following if the job description included with the application pack requires a car owner/car driver:
Do you hold a valid full driving licence? / Yes / No / Are you a car owner? / Yes / No
3. Disability Information
Disability Discrimination under the Equality Act 2010 defines a disability as ‘a physical or mental impairment, which has a substantial and long term effect on an individual’s ability to carry out a normal day – day activities’.
Do you believe you are covered by the description? Yes No
If you have answered yes, please give details of any arrangements or facilities you require to enable you to attend interview (e.g. sign language interpreter, level access etc):
Current or last employment (delete as applicable)
Name of Employer: / Start date:
Employer’s address: / Salary:
Post held:
Leaving date/notice period:
Telephone number: / Reason for leaving:
Please give a brief outline of your duties:
(b) Previous Employment – starting with the most recent, list your full job history, also accounting for any periods not employed or away from work since leaving full time education. If you need more space please attach a separate sheet.
Name of employer 1 / From (DD/MM/YY) / To
(DD/MM/YY) / Salary / Reason for leaving
Job title and main duties:
Name of employer 2 / From (DD/MM/YY) / To
(DD/MM/YY) / Salary / Reason for leaving
Job title and main duties:
Name of employer 3 / From (DD/MM/YY) / To
(DD/MM/YY) / Salary / Reason for leaving
Job title and main duties:
Name of employer 4 / From (DD/MM/YY) / To
(DD/MM/YY) / Salary / Reason for leaving
Job title and main duties:

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(a) School/College/University/Other attendance
School/College/University: / From (DD/MM/YY) / To
(DD/MM/YY) / Course of study and/or qualifications with grades obtained:
School/College/University: / From (DD/MM/YY) / To
(DD/MM/YY) / Course of study and/or qualifications with grades obtained:
(b) Short courses undertaken relevant to the post applied for:
(c) After full-time education did you undertake, or are you currently studying for, any professional or technical qualifications? Please give details:
(d) Membership of Professional/Technical bodies:

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Please provide work related referees that cover the last 3 years continuous employment with all gaps accounted for. One MUST be your present or most recent employer. If you are at school or college or have recently left please give the name of your teacher. Referees must not be colleagues, friends, and members of your family or spouse/partner. Please use additional paper if required. Please note references will be taken up once an offer of employment has been made.
First professional referee / Second referee
Title: / Title:
Surname: / Surname:
Occupation: / Occupation:
Relationship: / Relationship:
Company name: / Company name:
Address: / Address:
E-mail: / E-mail:
Telephone No: / Telephone No:
Start date (DD/MM/YY): / Start date (DD/MM/YY):
End date (DD/MM/YY): / End date (DD/MM/YY):
Title: / Title:
Surname: / Surname:
Occupation: / Occupation:
Relationship: / Relationship:
Company name: / Company name:
Address: / Address:
E-mail: / E-mail:
Telephone No: / Telephone No:
Start date (DD/MM/YY): / Start date (DD/MM/YY):
End date (DD/MM/YY): / End date (DD/MM/YY):

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7. SUPPORTING STATEMENT – you need to complete this section, as we want to know how you feel you meet the requirements of the job. Our shortlisting criteria are based on the qualifications, skills, knowledge and experience required for each job and we are looking for statements, which enable us to match applicants against the criteria as easily as possible. It would help us if you could address each section of the Person Specification in turn. If you require more space, please continue on a separate sheet. Please make sure you note your name, the job title and the reference number at the top of each page.
8. Cautions, Reprimands, Warnings, Convictions and Spent Convictions of a criminal nature
Some posts are exempted under the Rehabilitation of Offenders Act 1974 and, as such, appointment will be conditional upon the receipt of a satisfactory response to a check of criminal records via the Criminal Records Bureau before the appointment is confirmed. This will include details of cautions, reprimands, or final warnings, as well as convictions.
Applicant Authorisation
I know of no reason why CfBT would not be able to obtain an Enhanced Disclosure satisfactory to them and agree to complete a DBS Disclosure form if shortlisted for interview.
Are you a member of the DBS Update Service? Yes No
If yes, do you consent to CfBT carrying out a Status Check via the Update Service? Yes No
If no, are you willing to join up to the service at a cost of £13 per year? Yes No
Signed:
Data Protection Act 1998: Your data will be processed by CfBT in accordance with the UK Data Protection Act 1998. We acknowledge the rights of individuals volunteering their data, particularly the sensitive personal information gathered during recruitment processes.
Please note that your information may be shared with the third party organisations or bodies that CfBT have contractual relationships with and CfBT Group of Companies for recruitment and administrative purposes, including diversity monitoring. However, CfBT will seek your consent before passing your details to a third party in all other cases. Unsuccessful application forms are kept on file for six months, after which time they will be securely destroyed.
Declaration – I declare that the information I have given is, to the best of my knowledge, true and correct and may be stored and used in accordance with CfBT recruitment and selection procedures. I understand that canvassing or giving false information will disqualify my application or, if discovered after appointment, may be grounds for dismissal.
Signed: / Date:
Online applications: If you are submitting your application form via CfBT website, please tick this box (as substitute for your signature) to confirm that you agree to the above declaration. Please note that when you submit this form by email the information that is sent to us will not be encrypted. If you have any concerns about the security of information, please send your copy through the post to the address below quoting the relevant reference number on the envelope

PLEASE NOTE: If you have not heard from CfBT by the interview date (if a date was given) or one month of the closing date we regret that your application has not been successful.

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