ONFIDENTIAL

Job Application Form

Please complete all sections of the form using black ink or type.

The outside pages of this application form (which contain all your personal details and the equality opportunities information) will be detached and retained in Human Resources. This ensures that your application is dealt with objectively. Please complete these pages even if you are submitting a CV.

Data Protection Act Information from this form will be processed in accordance with the Data Protection Act 1998. In signing it you agree to this data being held and processed and if appointed to the job you also agree to further personal information, including sensitive data (e.g. bank details, medicals, etc) being held and processed by Cheshire West & Chester in accordance with the Act.

Cheshire West and Chester Council is under a duty to protect the public funds it administers. To this end we may use the information we hold for the prevention and detection of fraud, which also includes for the assessment and/or collection of any tax or duty. This will include sharing of information held internally and with external organisations where the law allows.

For internal candidates only
Are you on the Redeployment Recruitment List ? Yes No

Title of job applied for
Title of job applied for:	Ref:

Personal Details
Mr/Mrs/Miss/Ms/Dr	First Names:	Known as:
Surname: NI Number:
Previous Surname(s):
Address:
Post Code:

Telephone Numbers
Home:	Work:
Mobile:	E-mail address:
May we contact you at work? Yes No How can we contact you? Telephone / E-mail / Mobile

Where did you first see the advertisement for this job? If a newspaper, please state which one.

References
Please provide two referees. One of these must be your present or most recent employer, or, for students, your personal tutor or head teacher. The second should, preferably, be a previous employer or someone who can comment on your suitability for this job. Note –Council Recruitment Policy requires references to be provided by current line managers for internal candidates. Please nominate who that is under present/most recent employer. Please let your referees know that you have quoted them as a referee, to expect a request for a reference and clarify how best to contact them e.g. letter, e-mail, should you be shortlisted.
Present/most recent employer*	Previous employer/other
Organisation:	Organisation:
Name:	Name:
Role in Organisation:	Occupation:
Address:	Address:
Postcode:	Postcode:
Phone No:	Phone No:
E-mail:	E-mail:
Preferred method of communication: Letter E-mail Letter E-mail
In what capacity does the referee know you?	In what capacity does the referee know you?
Employer/former employer	Employer/former employer
Colleague/former colleague or manager but the reference is given on a personal basis	Colleague/former colleague or manager but the reference is given on a personal basis
Personal	Personal
If the referee knows you by a different name please state:
* If you have not had previous employment, please provide details of another referee. A reference will normally be taken up from your present/previous employer. Please tick the box if you do not want us to contact your referees without your prior agreement. However, if this job is working within Children's Social Care all references will be taken up prior to interview. Please do not contact my present/most recent employer

CONFIDENTIAL

Job Application Form

CVs will only be accepted in place of pages 3, 4, 5 and 6 if the information requested in these sections is covered. Please write the reference number at the top of your CV. You should not include the equality acts information on your CV.

Title of job applied for:	Ref:

Name:

Current/Most Recent Appointment
Title of current Job:	Start Date:
Current Employer:	Salary Range:
Employer Address:	Current Salary: £
Permanent or temporary contract:	Notice Required:

Main Responsibilities

Job related training
Brief details and dates of any training courses attended, excluding further education.

Current memberships of institutions/professional bodies
Please state level of membership, i.e. Graduate, Fellow, and membership number.

Employment History
(Most recent first) Name of Employer, type of Business and job title	Dates	Duties and reason for leaving

Relationship to Councillors or employees
If you have any personal relationship to any employee of Cheshire West & Chester, or to a Cheshire Councillor, please give their name and relationship. This does not stop a Councillor or employee giving a reference. (Any approach to Councillors or other employees to influence a selection decision will disqualify you). If Councillor: Name Relationship If Employee: Name Relationship Work location Their present job

Education and training

Do you have a qualification in English, maths and/or ICT*? Please list your highest full qualification attained:

Subject	Qualification	Grade Attained	Date
English
Maths
ICT

*Cheshire West and Chester Council is committed to supporting English, Maths and ICT skills across all its employees.

Please give details of schools and colleges attended from age eleven, including part-time education and other courses.
Secondary education (name and town of school)	Dates from / to	Qualifications gained or for which you are studying	Grade attained
Education and training after school (name and town of college/university)

Other Information
Additional skills e.g. languages sign language, keyboard skills. Do you have a valid driving licence? Yes No If yes, please state type of licence Does your licence have any endorsements or penalty points? Yes No If yes, please give details

Supporting Information
Please use this section to explain why you are applying for the job. Concentrate on how your experience, training and personal qualities match the requirements of the job description and person specification.
If you require more space please attach a separate sheet.

Activities and interests away from work which may be relevant to the job applied for.

Diversity
We are committed to equality of opportunity for everyone. To assess whether our Diversity policy is effective we need to monitor it and to do this we need the information requested below. We can then compare the success rates of different groups at both the shortlisting and appointment stages to ensure that unfair discrimination is not taking place This will also enable us to comply with our obligations under current legislation. The information below will be used only for monitoring purposes and not in the selection process. Please tick correct boxes: Do you describe yourself as? Male Female I use a different term Transgender Prefer not to say Is your gender identity the same as the gender assigned to you at birth? Yes No Do you currently live and work in the gender role opposite to that assigned to you at Birth? Yes No Marital Status: Married Single Civil Partnership Divorced Partner Separated Widowed Prefer not to say Date of Birth: Age: Please indicate your ethnic origin White: Mixed: Asian White British Mixed White/Black Caribbean Indian White Irish Mixed White/Black African Pakistani Gypsy/Traveller Mixed White/Asian Bangladeshi Any other White Other Mixed Chinese Other Asian Black or Black British: Other: Black Caribbean Arab Black African Other Other Black If other, (Please State) Nationality ( Please State) How would you define your sexual orientation? Bisexual Gay Man Heterosexual/Straight Lesbian/Gay Woman Other Prefer not to say What is your religious belief? Buddhist Christian Hindu Jewish Muslim Sikh No religion Prefer not to say

Disability: The Equality Act of 2010 made it unlawful for employers to discriminate against their employees who are disabled and places a duty on the employer to make reasonable adjustments to enable the employee to undertake the work. The Equality Act 2010 defines a disability as a mental or physical impairment that has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. Do you consider yourself to have a disability? Yes No

Have you any unspent convictions? If so please give details.
If between the completion of this application form and taking up a job with the Council you are convicted of a criminal offence you must inform the Council of this.

The Rehabilitation of Offenders Act (only complete this section if instructed to do so on the Job Description and Person Specification enclosed with this form) The Rehabilitation of Offenders Act allows for a person who has been convicted of a criminal offence involving a sentence of not more than 2½ years imprisonment and who has since lived trouble free for a specified period of time (related to the severity of the offence) to be treated as if the offence, conviction or sentence had never occurred. This is known as a spent conviction*. The job for which you are applying is one of those to which the provisions of the above Act in relation to spent convictions*, do not apply. You must, therefore, disclose whether you have any previous convictions*, whether or not they are spent. Should you identify that you have a criminal conviction*, this will be discussed in confidence at interview. However you should note that only convictions* that are relevant to the job in question will be taken into account. Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198? Yes No Please Note before Completing Certain spent convictions* are 'protected' and are not subject to disclosure to employers, and cannot be taken into account by a recruitment manager. Guidance and criteria on the filtering of these convictions* can be found at the following link; please read before completing this question: http://www.legislation.gov.uk/uksi/2013/1198/pdfs/uksi_20131198_en.pdf *including cautions, reprimands or warnings
If yes please state:
If you do not disclose any conviction* you have it could lead to your application being rejected, or, if you are appointed, may lead later to your dismissal. People who have convictions* will be treated fairly and given every opportunity to establish their suitability for the job. Any information that you give will be kept in strict confidence and will be used only in respect of your application for this job. As part of the recruitment process we will check our records for information we hold about you in relation to your suitability for the post for which you have applied. Disclosure and Barring Service Successful applicants will be asked to apply for a Criminal Record Check (Disclosure) from the Disclosure and Barring Service. Please check the Job Description and Person Specification to identify the level of check required for the position for which you are applying. A copy of the Disclosure and Barring Service Code of Practice is available on request. Further information about the Disclosure process can be found at https://www.gov.uk/government/organisations/disclosure-and-barring-service
I certify that the details on this application form and any supplementary information attached are true as far as I know. I understand that if I give false information or withhold relevant information, it could result in my dismissal. Signed Date

Cheshire West & Chester has a duty to protect public funds and may use the information you have provided for the prevention and detection of fraud. It may also be shared with other public bodies solely for these purposes.