Support Application Form A - Christ's Hospital

Post Applied for*

How did you first find out about this role?*

1 - PERSONAL DETAILS

Name

Title First Last

Maiden/Former Name(s)

Current Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

May we discreetly contact you at work*

Yes
No

Home telephone number*

Mobile telephone number*

Email Address*

2 - PRESENT / MOST RECENT EMPLOYMENT

Name of Current Employer*

Address of Current Employer*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Position held*

Date Employment Commenced*

Notice required*

Salary, and any Other Allowances*

Please give a brief description of your current duties & responsibilities*

Reasons for leaving / wishing to leave:

3 - PREVIOUS EMPLOYMENT:

Please provide a full history of your employment, education and training in chronological order since leaving secondary education. You must include start and end dates and reasons for leaving employment and explanations for periods not in employment, education or training. There must be no gaps that are unexplained.
Please ensure any employment gaps are accounted for.

Name of Employer & Nature of Business

Position Held

From

To

Main Duties

Reason for Leaving

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4 - EDUCATION & QUALIFICATIONS:

School(s) and University*

Please include the date to and from attended

Qualifications*

When completing this section can you ensure you include all qualifications you have received from GCSEs onwards and include the subject taken, date taken and grade received for each one.

Date leaving secondary/ compulsory education*

month and year of leaving secondary school education

5 - TRAINING UNDERTAKEN

(please list courses that are relevant to this position)

Training Course

Organising Body

Date

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6 - MEMBERSHIP OF PROFESSIONAL BODIES

(if relevant to the role)

Name of Organisation/Institution

Level of Membership

Membership number

Expiry Date

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7 – COMPUTER/SOFTWARE EXPERIENCE

(please provide details of computer software packages you are competent in i.e. Word, Excel, PowerPoint)

Computer/Software package

Level of competence (i.e. basic, intermediate, advanced)

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8 - DRIVING LICENCE

(for roles involving driving only)

Do you hold a current driving licence?

Yes
No

Do you have any endorsements?

(please detail)

What class of vehicle are you licensed to drive?

9 – PERSONAL STATEMENT

Please outline the reasons why you feel you are the right person for the position.*

10 – ADDITIONAL INFORMATION

Please declare any family or close relationship to existing staff, pupils, Council Members or Governors.

Yes
No

Who?

11 – RIGHT TO WORK IN THE UK

We need to know that you are entitled to live and work in the UK. We are unable to provide sponsorship.

Do you require a permit to work in the UK?

Yes
No

Do you have a current permit to work?

Yes
No

Please provide details of your current work permit

12 – REASONABLE ADJUSTMENTS

Is there any disability you wish us to know about that may affect the presentation of your application?

Yes
No

Please give details...

13 - DISCLOSURE OF CRIMINAL BACKGROUND

All posts involving direct contact with vulnerable children are exempt from the Rehabilitation of Offenders Act 1974.The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected'. These 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 on the Disclosure and Barring Service website.

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)

Yes
No

If you have answered yes, Please supply details separately by email to hr@christs-hospital.org.uk. If your application is successful, this information will be checked against information from the Disclosure & Barring Service before your appointment is confirmed. (Further information about the Disclosure Scheme can be found at www.gov.uk/disclosure-barring-service-check).

14 - VETTING & BARRING

I declare that I am not currently disqualified/barred from working with children and that there are no cases that are currently outstanding regarding my suitability or otherwise to work with or in proximity to children, nor am I or subject to any sanctions imposed by a regulatory body.*

I agree

15 - REFERENCES

Completion of this section is mandatory in order for Christ’s Hospital to comply with legislation.

Please give the names and addresses of 2 people for whom you have worked from whom we may obtain references, one of these should be your current / most recent employer. Please note that references will not be accepted from relatives or from referees writing solely in the capacity of friends. If you are not currently working with children but have done so in the past, a reference will be sought from the most recent employer for whom you have worked with children or vulnerable adults

Name

First Last

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone Number

Email Address

Occupation / Position in Organisation

Relationship of referee to you

Can we approach this referee prior to interview?

Yes
No

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Please tick the following statement to acknowledge your acceptance of this entitlement.

I understand and accept that Christ’s Hospital is entitled to approach any previous employer and request references. Additionally, I understand that where I have worked for an employer who provides services, care or education for children or vulnerable adults, they will be approached for a reference.

16 - DECLARATIONS & SIGNATURE

Once completed, this form will be treated as confidential and will only be processed in accordance with current data protection legislation. Further information is available in the Christ’s Hospital Privacy Notice https://www.christs-hospital.org.uk/privacy-notice/ available on the intranet or the School Internet. The information it contains will only be shared with the person to whom it applies, their line manager and other appropriate members of staff, strictly with a “need to know”. We will only transfer the information we hold about you to third parties outside Christ’s Hospital for the effective running of the organisation or where we are required to do so by law. The completed form will be stored securely in the HR department.
.
• I hereby give my consent to Christ’s Hospital processing the data supplied in this application form for the purpose of recruitment and selection.
• I declare that the information given in this application is to the best of my knowledge complete, true and correct and that there are no material mis-statements or omissions. I declare that I am in possession of the certificates that I claim to hold.

Signed*

Typing in your name acts as your signature.

Date*