and
Diocese of Newcastle
Application Form /
The front pages of this form will be detached before shortlisting takes place
Application for Employment as(delete as appropriate) / Assistant Director of Education
Secondary and FE
Family Name / Names in Full Title
Address
Postcode / Telephone
Date of Birth / Male [ ] Female [ ] (Please tick)
Please give details of any periods of more than five consecutive days in the past 2 years when you have been unable to work.
If you have a disability please tell us about any adjustments we may need to make to assist you at interview or to help you do your job.
Are there any restrictions on your residence or employment in the UK? / No [ ] Yes [ ] (Please give details)
Applications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this job will not be taken into account. You are required to disclose any convictions, which are not ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974. Please note that appointment to this post is subject to receipt of a satisfactory enhanced Criminal Records Bureau disclosure.
Have you been convicted of a criminal offence which is not spent? / No [ ] Yes [ ] (Please give details)
This post is exempt under paragraph 7(3) of the Employment Equality Regulations 2003 – Religion or Belief. The Diocese of Durham and the Diocese of Newcastle support and promote the aims of the Church of England.
I confirm that to the best of my knowledge the information in this form and the attached sheets is correct. I accept that providing deliberately false information could result on my dismissal. I agree that my records may be maintained on a computerised database that is subject to the Data Protection Act 1998.
Signature / Date
1.Education and Training: please list all training and qualifications which are relevant to this post whether or not they resulted in formal qualification.
School / Course/Subject / Qualification/Grade / Date Obtained
Further/Higher Education / Course/Subject / Qualification/Grade / Date Obtained
Other / Course/Subject / Qualification/Grade / Date Obtained
2.Employment History
a)Please tell us about your present or most recent employer
Name of Employer
Address / Postcode
Job Title
Summary of Duties/Responsibilities
From / To
Reason for leaving (if applicable)
b)Please tell us about other jobs you have done, and about any periods when you were not in paid employment, including unpaid and voluntary activities. Begin with the most recent and work backwards.
From To / Employer / Job/Activity
Main Responsibilities / Reason for Leaving
From To / Employer / Job/Activity
Main Responsibilities / Reason for Leaving
From To / Employer / Job/Activity
Main Responsibilities / Reason for Leaving
From To / Employer / Job/Activity
Main Responsibilities / Reason for Leaving
2b)continued
From To / Employer / Job/Activity
Main Responsibilities / Reason for Leaving
From To / Employer / Job/Activity
Duties/Responsibilities / Reason for Leaving
(continue on a separate sheet if necessary)
3.Personal Statement: Please tell us why you are applying for this job and how you meet the requirements of the person specification. Give examples of things you have done that make you particularly suited to the job
(continue on a separate sheet if necessary)
4.Leisure Interests: Please tell us about your main leisure interests/hobbies
5.Other Information: Please include any information you feel relevant to your application
Please return completed applications to Vanessa Ward at Church House, St John’s Terrace, North Shields, NE29 6HS bynoon on 15th February 2010.
Equal Opportunities Monitoring Form
You are invited to answer the questions below. This information will be held securely and confidentially and used solely for the purpose of monitoring. By completing and returning this form, you are consenting to the use of this information for this purpose.
Please put an X in the relevant box.
Gender
( ) Female / ( ) Male
Age
( ) 16 - 25 / ( ) 26 - 35 / ( ) 36 - 45 / ( ) 46 +
Ethnicity
ASIAN / BLACK / MIXED / WHITE / CHINESE / OTHER
( ) Asian British / ( ) African / ( ) White/Asian / ( ) British / ( ) Chinese
( ) Bangladeshi / ( ) Black British / ( ) White/
Black African / ( ) Irish / ( ) Any Other
( ) Indian / ( ) Caribbean / ( ) White/
Black Caribbean / ( ) Other
( ) Pakistani / ( ) Other / ( ) Other
( ) Asian Other
Marital Status (Please indicate which of the following best describes your marital status.)
( ) Single / ( ) Married
( ) Separated / ( ) Divorced
( ) Widowed / ( ) Undeclared
Disability: Do you have a disability as defined by the Disability Discrimination Act 1995?
( ) Yes / ( ) No
If yes, please indicate which of the following best describes your disability.
( ) Co-ordination, dexterity, mobility / ( ) Visual / ( ) Mental Health
( ) Speech / ( ) Learning difficulties / ( ) Hearing
( ) Other (please specify)
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