Borough Council of
Wellingborough / Human Resources
Swanspool House
Wellingborough
Northants
NN8 1BP
Telephone: 01933 229777
Fax: 01933 231832
EMPLOYMENT APPLICATION FORM
Please complete in black ink or electronically.

This first page of your application will be detached and not seen by those conducting the selection process.

Post Applied for:
Directorate/Service:
Title:Full Name: (BLOCK CAPITALS)
Have you ever been known by any other name? YES □ NO □ If yes, please give details:
Address: / Contact Information:
Home Telephone:
Work Telephone:
Mobile Telephone:
E-mail address:
National Insurance Number:
Note:You should not approach any Elected Member or Employee of the Borough Council in order to advance your appointment by canvassing as this will disqualify you from consideration.
Are you related to any Elected Member or Senior Officer of the Borough Council of Wellingborough?
YES □ NO □
If yes, please give details:
The information I have given in this application is correct to the best of my knowledge. Providing false information may result in termination of your employment if you are successful.
Signed: …………………………………………… Date: ……………………………………….….
/
We believe in
Equal Opportunities for all /
Candidate Number:

The Borough Council operates an equal opportunity policy to ensure that every person receives equal treatment. In order to assist us in checking that this policy is fully carried out, and for no other reason, would you please provide the following information:-

1.I would describe myself as (please tick one box only):
White □Black-Caribbean □ Black-African □Black-Other □
Indian □Pakistani □ Bangladeshi □Chinese □
Other □Irish □
2.Sexual Orientation:
Homosexual □ Bisexual□ Heterosexual □
  1. I would describe my religious beliefs as (please tick one box only):
Baha’i □Buddhism □Christianity □Hinduism □
Jainism □Judaism □Islam/Muslim □Rastafarianism □
Sikhism □Zoroastrianism/Parsi □ None □Other □
I do not wish to provide the above information □
4.Age: years / Date of Birth:
5.My gender is (please state):
  1. My marital status is (please tick appropriate box):
Single □Divorced□Widowed □Separated □
Married or Civil Partnership □
7.How many days absence from work through illness have you had in the past two years?
………………… days
8.Do you have a disability or health problem which affects the kind of work you can do and which is likely to last for twelve months or longer?
YES □ NO □
If yes, please:-
(a)give brief details: ……………………………………………………………………………………….
……………………………………………………………………………………………………………….
(b)give the name and address of your General Practitioner: …………………………………………
……………………………………………………………………………………………………………….
(c)I hereby give consent for the Borough Council of Wellingborough’s medical adviser to make enquiries as he considers necessary of my General Practitioner to verify the nature of my disability/health problem.
YES □ NO □
  1. Please give details of any convictions you have received for offences which may not be regarded
as spent in respect of this vacancy under the Rehabilitation of Offenders Act, 1974:

CANDIDATE NUMBER:

1. PRESENT EMPLOYMENT
EMPLOYER’S NAME
DEPARTMENT / TELEPHONE NUMBER
ADDRESS
DATE APPOINTED
JOB TITLE / DATE LEFT (if applicable)
SALARY / NOTICE REQUIRED
2.PREVIOUS EMPLOYMENT
EMPLOYER’S NAME & ADDRESS / DATES / JOB TITLE
& SALARY / REASON FOR LEAVING
FROM / TO
3.PROFESSIONAL/EDUCATIONAL QUALIFICATIONS
(Proof of qualifications will be required at interview.)
EDUCATIONAL
QUALIFICATIONS / LEVEL / ESTABLISHMENT
TRAINING
(including membership of professional bodies) / GRADE / ESTABLISHMENT
4. OTHER INFORMATION
Do you hold a current valid driving licenceYES/NO*
Do you have use of your own transportYES/NO*
How did you learn of this vacancy?
5. REFEREES
Please provide the names and addresses of two referees. One must be your present employer or, if you are not currently in employment, your last/most recent employer.
Please tick the box(es) if you would prefer references to be taken up after the interview.
Note:References for short-listed candidates are normally taken up prior to interview unless you specifically request otherwise.
□
Name:
Address:
Position: / □
Name:
Address:
Position:
Please note that you will be asked to provide an alternative referee if you provide details of a family member or an employee of the Borough Council of Wellingborough.
6. INFORMATION TO SUPPORT YOUR APPLICATION
Please demonstrate how you meet the requirements of this post as set out in the job description and person specification provided. Please continue overleaf if necessary.