Employment Application M05

Please complete ALL sections of the form

N.B. Sections B and C of the application form will be detached and retained in Human Resources to ensure that your application is dealt with objectively

1. Job Details	Please provide details of the job for which you are applying
Job Title:
In the department of:
Post Number/Job Reference:	Closing date:
2. Personal details
First Name(s):	Last Name:
Address:	Contact Details:
Daytime:
Mobile:
Post Code:	Email address:
National Insurance Number:
3. Present or Most Recent Employer / Employment
Name:	Period From:
Address:	Period To:
Telephone Number:
Basic salary:
Post Code:	Notice period:
Nature of business:
Position held:
Nature of responsibilities:
Reason for leaving:

4. Education, Training & Development
Please tell us about your education, beginning with the most recent. You must complete this section if some kind of educational attainment is stated as an essential or desirable attribute on the employee specification (M23). You may include relevant training courses.
Date From	Date To	Name of School, College, University or Training Provider	Course Details, Qualifications Gained (specify grade/level)
5. Membership of Professional Organisations
Date Joined	Institute/Organisation	Grade of Membership (where required)
6. Previous employment (in date order, starting with most recent) - Please state all employment including voluntary work. Please account for any gaps in employment. Failure to do so may result in your application not being considered – particularly if you are applying for a job which is exempt from the Rehabilitation of Offenders Act 1974. Please continue on a separate sheet if necessary.
Name of Employer and Type of Business:	From	To	Job Title, Grade & Salary	Brief summary of duties and reason for leaving (if applicable):
(state month, year)
7. Previous Employment with Wirral Council
Have you ever worked for Wirral Council in any capacity? (If you answered ‘yes’ please complete questions below)	Yes No
Date of leaving:	Reason for leaving:
Have you ever accepted Voluntary Severance, Early Voluntary Retirement or discretionary compensation from Wirral Council?	Yes No

8. Essential and desirable criteria – see enclosed employee specification (M23)
The employee specification which was enclosed with this application form gives details of the essential and desirable attributes of our ideal candidate. Please use this opportunity to state clearly how you meet each of the criteria set out in the employee specification. Give a brief summary of your reasons for applying for this post. Please continue on a separate sheet if necessary.

9. Reference details
Please give the names and addresses of two people who would be willing to provide a reference concerning your application. One of the referees must be your current/last employer who will be asked specifically about your attendance record.
Name:	Name:
Address:	Address:
Post Code:	Post Code:
Daytime contact number:	Daytime contact number:
Email address:	Email address:
Is this person your present or previous employer?	Yes No	Is this person your present or previous employer?	Yes No
If you answered ‘no’ to the above question, in what capacity does the referee know you?	If you answered ‘no’ to the above question, in what capacity does the referee know you?
References will normally be taken up prior to interview. Please indicate if your referee can be contacted at this stage.	References will normally be taken up prior to interview. Please indicate if your referee can be contacted at this stage.
Yes	No	Yes	No
10. Relationship to existing council employees or councillors
If you have any personal relationship to any Wirral Councillor, member of a committee of the council or employee of the council, please give their name and relationship. Any approach to Councillors or other employees to influence a selection decision will disqualify you. This does not stop a Councillor or employee giving a reference

11. Your availability
Please tell us when you are not available for interview in the 6 weeks following the closing date for this post. This does not guarantee that we will be able to accommodate your needs, particularly where an interview date has already been indicated.

12. Guaranteed Interview Scheme
Wirral Council is positive about disabled people and committed to their employment. The Council’s policy is that any disabled applicant who meets the minimum (essential) criteria for the job will be interviewed.
Do you wish to apply under the Guaranteed Interview Scheme? Yes No

13. Driving or car ownership status
If the job for which you are applying requires you to drive or carries an Essential Car User allowance please answer the following questions.
Are you a vehicle owner?	Yes	No
Do you hold a full clean current licence?	Yes	No
If No, please give details of any penalties or endorsements
Please state any other type of licence you hold (e.g. HGV)
14. Declaration
I certify that the information contained on this application form is accurate and true. I give my consent to the processing, transfer and disclosure by Wirral Council of all the information submitted by me during the recruitment process and throughout my subsequent periods of employment for pre-employment checks, equal opportunities monitoring, payroll operations, training and absence records (Data Protection Act 1988). (N.B. Deliberate falsification or withholding of information will lead to disciplinary proceedings and may result in dismissal.) I understand that canvassing will automatically disqualify my application. If you return this form without a signature you will be assumed to have accepted the above declaration.
Signature:	Date:

Thank you for your application.

This should be returned to: schooloffice@pensbyprimaryschool.org OR posted to:

Pensby Primary School

Greenbank Drive

Pensby

Wirral

CH61 5UE

Section B –Monitoring of Equality & Diversity
Wirral Council aims to promote equality of opportunity for all with the right mix of talent, skills and potential. We welcome applications from diverse candidates. Why do I need to complete Equality & Diversity Questions? The Council has a legal duty to promote equality. This duty applies to everything the Council does, both as an employer and a provider of services. In order to help us, please answer the following questions and complete the declaration at the bottom of the end page. What happens to the Equality & Diversity information? All data, in accordance with the Data Protection Act will be confidentially retained and used only for the purpose of reporting to Committee and for the production of statistical reports. The Equality & Diversity data will only be recorded and maintained on the employee’s personal record on the Council’s Human Resources system and used for the purpose of statistical reports in relation to equality and performance indicators including recruitment.
Title of the job applied for:
Post No/Job Reference No:
Closing Date:
Please repeat your Personal Details
Title:	Full Name:	Marital Status:
Age
What is your date of birth?
Race & Ethnicity
What is your ethnic group? Please tick the relevant ethnic group. If you are in an ‘Any Other Background’ category please state what it is.
A. White	English Other British Irish Any Other White Background*
B. Mixed	White & Black-Caribbean White & Black-African White & Asian Any Other Mixed Background*
C. Asian or Asian-British	Indian Pakistani Bangladeshi Chinese Any Other Asian Background*
D. Black or Black-British	Caribbean African Any Other Black Background*
E. Other Ethnic Group	Arab Gypsy/Romany/Irish Traveller Any Other Ethnic Group*
F. Do not wish to declare	Do not wish to declare

Country of Birth
What is your country of birth? England Wales Scotland Northern Ireland Republic of Ireland Other (please write in the current name of the country) Do not wish to declare
Religion or Belief
What is your religion or Belief? *If you have “Any Other Religion or Belief” then please state what it is. None Christian (including Church of England, Catholic, Protestant & all other denominations) Buddhist Hindu Jewish Muslim Sikh Humanist Atheist Agnostic Pagan Any other religion or belief* Do not wish to declare
Nationality
What is your nationality? (e.g. English, British, French, Spanish etc) Do not wish to declare
Sexual Orientation
What is your sexual orientation? Heterosexual Lesbian or Gay Bisexual Asexual Do not wish to declare
Disability
The Council takes a positive approach in the selection of people with disabilities, including interviewing all disabled persons who meet the essential selection criteria. The Disability Discrimination Act 1995, defines disability as “a physical or mental impairment which has substantial and long-term adverse effect on the ability to carry out normal day to day activities”.
Do you consider yourself to be a disabled person? Yes No Do not wish to declare
If ‘Yes’ please provide details of any adjustments we might need to make in order to fulfil your needs at interview:

Marriage/Civil Partnership
Are you currently married? Yes No Or in a civil partnership? Yes No Do not wish to declare
Gender
What is your gender? Male Female Do not wish to declare
Gender Reassignment
Is your gender identity the same as the gender you were assigned at birth? Yes No Do not wish to declare
In order to improve the way in which we advertise in future, please tell us how you found out about this vacancy:
Job Centre	Personal recommendation
Internal Human Resources Bulletin	Newspaper or other publication*
One Stop Shop	Internet/Intranet*
Other*
Confirmation of Declaration
The details given by me are correct to my knowledge and belief.
Signature:	Date:

Section C – Criminal Offences
Safer Recruitment & Employment Policy Statement “Wirral Council is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all employees and volunteers to share this commitment.” Whilst the Council supports the rehabilitation of ex-offenders it is committed in the recruitment of all employees to ensure safer recruitment to posts which involve working with children, vulnerable adults and/or to other positions of trust. Therefore certain posts due to the nature of the work being undertaken are subject to a Disclosure and Barring Service Check (DBS). If the post is subject to a DBS check this will be stated in the job advertisement; to ensure that you declare relevant information please read the Council’s Safer Recruitment & Employment Policy (which is included in the Recruitment Pack or is available to download on www.wirral.gov.uk). All candidates who are successful at interview for one of these posts must undertake a DBS check before the appointment can be confirmed. Please note you will be required to verify your identity by producing original documents at interview. We will process the application and pay the charge to the Disclosure and Barring Service. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service website (a summary of the filtering criteria is enclosed in the Council’s Recruitment Pack). Applicants should be aware that having a conviction or a record of some type of unacceptable behaviour would not necessarily bar you from employment, as any decision to employ will be considered on the individual circumstances of each case. The Council will consider ALL applications on their merits, only taking into account convictions considered to be relevant to the job applied for.
Title of the job applied for:
Post No/Job Ref No:	Closing Date:
Please repeat your Personal Details
Title:	Full Name:
Declaration of Criminal Offences
Have you ever been convicted, or received a caution, warning or final reprimand, for an offence that will not be filtered from the Police National Computer (PNC) by the Disclosure & Barring Service (DBS)?
No Yes
If Yes please give details:
Confirmation of Declaration
The details given by me are correct to my knowledge and belief. I understand that my application may be rejected or my employment may be terminated for withholding relevant details or giving false information. This declaration also covers information provided in a CV or any other supporting document.
Signature:	Date:

HR Office Use only:
Post requires	Enhanced	Standard	DBS Disclosure Check or	None required