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Job Application Form

Post applied for:
Please complete this form in type or write clearly in black ink
Title: / Initials or forename: / Surname:
Address: / Contact numbers, including telephone and email
Home telephone:
Daytime telephone:
Email:
May we contact you at work?
Courses and qualifications
Please list courses you have attended and qualifications you have gained, starting with the most recent.
Courses and qualifications / School/College/Agency / Year / Duration

Present or most recent post

Name of employer:
Address of employer:
Title of post held:
Date appointed: / Notice required:
Leaving date (if appropriate): / Salary:
Main duties and responsibilities of most recent post:
Previous experience (This can be paid or unpaid work). Please show most recent post first.
Name of employer /
Paid or
unpaid / From
month/year / To month/year / Post and main duties / Reason for leaving
Personal statement
Please state the reasons why you are applying for the post and what you think you can bring to it and to the organisation. Continue on a separate sheet if necessary.
Referees
Please give the names of two referees, one of whom should be your present or most recent employer. Please note that you may not give the name of someone who is related to you. May we approach these people prior to interview should you be shortlisted? Please indicate this below.
Name: / Name:
Address: / Address:
Job title: / Job title:
Relationship to you: / Relationship to you:
Telephone: / Telephone:
Email: / Email:
May we approach this referee if you are shortlisted? / Yes/No / May we approach this referee if you are shortlisted? / Yes/No
The information in this application is a true record of my personal situation.
Signature: / Date:
Please return your completed form to the address below, either by post or by e-mail.
Please also return your equal opportunities monitoring form with your application, all applications are opened by a member of staff not involved in the interview process. The monitoring form is detached from your form and stored separately and is not seen by the interview panel. We use the monitoring forms for equality monitoring only.
Applications to:

LGBT Youth Scotland

Recruitment
40 Commercial Street
Edinburgh
EH6 6JD / Email:
Tel: 0131 555 39 40


Self-Declaration Form - Childcare Position

Private and confidential

The post that you have applied for is for a childcare position. The position is therefore exempt from the Rehabilitation of Offenders Act 1974 by the Exclusions and Exceptions (Scotland) Order 2003 the Police Act 1997 (Criminal Records) (Scotland) Regulations 2006. You are therefore required to disclose all convictions (spent and unspent), cautions and any relevant non-conviction information.

Part A: Previous convictions – this section should be completed by all applicants.

Date(s) of conviction(s):
Court(s) where your conviction(s) were heard:
Type of offence(s):
Sentence(s) received
Please give details of the reasons and circumstances that led to your offence(s)
Please give details of how you completed the sentence(s) imposed, (for example did you pay your fine(s) as required; what conditions were attached to your probation/community service/supervised attendance order(s), did you comply with the requirements of your custodial sentence(s).
Have any other organisations supported you to work through any of the above issues/difficulties?
What have you learned from your experience?

Part B – Details of any disciplinary action relating to behaviour to children and young people – this section should be completed by all applicants

Have you been disciplined because of inappropriate behaviour towards a child or young person, which may have harmed them or put them at risk of harm?
YES NO (Please underline)
If YES, please give details.

Part C: Police Investigations – this should include relevant police non-conviction information.

Date of investigation(s):
Police Division(s) involved:
Details of investigation(s)
Please give details of the reasons and circumstances that led to your investigation(s):
Disposal(s) if known:
Are you, or have you ever been, known to any Social Work Department/Social Services Department (in England and Wales) as an actual or potential risk to children?
YES NO (please underline)
If yes, please provide details

Part D: The Protection of Children (Scotland) Act 2003 Self Declaration – this section should be completed by all applicants.

Before answering the question below, please read the following notes:

Section 11 of the Protection of Children (Scotland) Act 2003 creates a new offence which an individual who is disqualified from working with children will commit if they apply for, offer to do, accept or do any work in a childcare position. An organisation will also be guilty of an offence if they knowingly employ (paid or unpaid) a disqualified person in a childcare position.

Section 17 of the Protection of Children (Scotland) Act 2003 defines “disqualified from working with children”. It extends to Scotland disqualifications, which previously applied in England and Wales only. A person is disqualified from working with children if they are:

Included (otherwise than provisionally) in the Disqualified from Working with Children List established under section 1(1) of the Protection of Children (Scotland) Act 2003;

o  Included (otherwise than provisionally) in the List kept under section 1 of the Protection of Children Act 1999;

o  On List 99 and subject to direction under subsection (1)(a) of section 142 (prohibition from teaching etc.) of the Education Act 2002 given on the grounds mentioned in subsection (4)(b) of that section, not to carry on work to which that section applies;

o  Subject to a Disqualification Order within the meaning of the Criminal Justice and Court Services Act 2000.

To help us ensure we are complying with the new child protection laws, please complete the following declaration:

  • I ______[full name in block capitals]

Of [address]______

______confirm that I am not

subject to any of the disqualifications set out in section 17 of the Protection of

Children (Scotland) Act 2003

OR

  • I am the subject of a disqualification from working with children under

______

I understand that deliberately giving false information can result in prosecution.

Signed ______Date ______

Part E: Declaration –this section should be completed by all applicants:

I hereby declare and represent that, except for as disclosed above, I have not at any time, whether in the United Kingdom or abroad, been found guilty and sentenced by a court for a criminal offence.

I give my consent to LGBT Youth Scotland carrying out a Disclosure check (if appropriate) and to requesting references for the purposes of verifying the replies given in this declaration, including enquiries of any relevant authority.

I agree to inform LGBT Youth Scotland if I am convicted of an offence after I take up any post within the organisation. I understand that failure to do so may lead to the immediate suspension of my work with children with the organisation and/or the termination of my services.

If I am appointed to a childcare post, I agree to abide by the organisation’s Code of Conduct and Child Protection Policy and Guidelines.

I agree to abide by the conditions above and certify that the information contained in this form is true and correct to the best of my knowledge and I realise that false information or wilful omissions may lead to the immediate suspension of my work with children or the termination of my services.

  • Signed: ______
  • Date:______

Please not that any information you give in this form will be managed according to the organisation’s Confidentiality Policy.

If you are returning this form electronically then we will accept an electronic signature. If you do not have an electronic signature then please type your name and date to confirm you agree to abide by the conditions above.

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Equal Opportunities Monitoring Form

About this form
LGBT Youth Scotland is committed to equal opportunities in its employment, policy, practices and procedures. Filling in this form will give us some of the information we need to monitor our performance in respect of equal opportunities.
The information you provide will not be used as part of the selection process for the job you have applied for and will be processed separately from your application. The information will be treated confidentially, for the purposes of equality monitoring.
How to fill in this form
Please mark the relevant boxes, and if space is provided to write an answer, please write clearly in BLOCK capitals. Feel free to leave any question that you do not wish to answer.
  • AGE

☐ 16-20 ☐ 21-30 ☐ 31-40 ☐ 41-50 ☐ 51-60 ☐ 61-65 ☐ Over 65

  • DISABILITY
  • Do you consider yourself to have a disability?

Definition of disability: 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. (Equalities Act 2010)

☐ Yes ☐ No

Please specify here: ______

Any other information you would like to disclose: ______

  • GENDER
  • How would you describe your gender identity?

☐ Woman (including male-to-female trans woman) ☐ Man (including female-to-male trans man)

☐ Other gender identity (for example, androgyne person)

If ‘Other’, please specify here: ______

  • Is your gender identity different to the gender you were assigned at birth?

☐ Yes ☐ No

  • Have you ever identified as a transgender or trans person?
    (Equality organisations use the terms "transgender" and "trans" as inclusive umbrella terms for a diverse range of people who find their gender identity differs in some way from thegender they were originally assignedat birth.)

☐ Yes ☐ No

Any other information you would like to disclose: ______

  • RACE

☐ White ☐ Black ☐ Asian ☐ Mixed ☐ Other

If ‘Mixed’ please specify ______

If ‘Other’ please specify ______

  • NATIONALITY

☐ Scottish ☐ British ☐ Irish ☐ Bangladeshi ☐ Pakistani

☐ Chinese ☐ African ☐ Caribbean ☐ Other

If ‘Other’ please specify ______

  • ETHNICITY

☐ Gypsy/Traveller ☐ Jewish ☐ Sikh

☐ Other Ethnic Background, please specify ______

  • RELIGION or BELIEF
  • What, if any, religious or belief group do you belong to?

☐ None ☐ Buddhist ☐ Church of Scotland ☐ Christian (other)

☐ Hindu ☐ Humanist ☐ Jewish ☐ Muslim

☐ Pagan ☐ Roman Catholic ☐ Sikh ☐ Other

If ‘Other’, please specify here: ______

  • SEXUAL ORIENTATION
  • How would you describe your sexual orientation?

☐ Asexual ☐ Bisexual ☐ Gay ☐ Lesbian

☐ Heterosexual/Straight ☐ Pansexual ☐ Queer ☐ Questioning

☐ Other Sexual Orientation

If ‘Other’, please specify here: ______

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