CHURCH OF ENGLAND - DIOCESE OF SOUTHWARK

RECEPTIONIST/REPROGRAPHICS APPLICATION
CONFIDENTIAL
SOUTHWARK DIOCESAN
BOARD of
EDUCATION
NAME OF SCHOOL: Christs Schoo
POST APPLIED FOR: R!c!"tio#ist/R!"ro$r%"hics
Closing date for completed form: 9am, Monday 19
th
May 2014
Return form to: Amanda Mylles at: amylles@christsrichmondschu!
Christ"s school
#ueen"s Road
Richmond
$urrey
%&10 '(&
to )hom all *ueries should +e addressed
,lease state )here you
sa) the ad-ertisement
for this post:
& APPLICANT'S PERSONAL DETAILS
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( SUPPORTING STATEMENT
&ith reference to the :o-ernors; selection criteria, please gi-e details of your e<perience, s!ills, a+ilities and
personal *ualities that you +elie-e are rele-ant to your suita+ility for the post and indicate ho) you meet the person
specification Also pro-ide any additional information )hich you thin! )ould +e useful in this =o+ ,lease )rite this on
a separate sheet>s? of paper
1
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) PRESENT OR MOST RECENT EMPLO*MENT
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+ PRE,IOUS EMPLO*MENT -st%rt .ith /ost r!c!#t 0 "!%s! !1"%i# %#2 $%"s i# !/"o2/!#t3
0sta+lishment at )hich
employed
2ature of employment
and Ao+ %itle
$cale,
grade,
allo)ance
etc
$pecial
responsi+ility
>if applica+le?
6ates of
employment and
reasons for
lea-ing
4 EDUCATION AND ACADEMIC 5UALIFICATIONS
1rom %o 2ame of
school@college@uni-ersity
#ualifications@certificates
state su+=ects and grades
6ate of
*ualifications and
a)arding +ody
2
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6 AN* TRAINING COURSES UNDERTAKEN DURING THE PAST 7 *EARS RELE,ANT TO THIS APPLICATION
Course title ,lace of $tudy 6ates of course A)ard >if any?
8 PROFESSIONAL REFERENCES - "!%s! s9""2 th! #%/!s %#: %::r!ss!s o; t.o "!rso#s .ii#$ to "ro<i:!
r!;!r!#c!s= O#! r!;!r!#c! sho9: >! ;ro/ 2o9r "r!s!#t or /ost r!c!#t !/"o2!r= I; 2o9 %r! #ot c9rr!#t2
.or?i#$ .ith chi:r!#@ % r!;!r!#c! ;ro/ th! !/"o2!r >2 .ho/ 2o9 .!r! /ost r!c!#t2 !/"o2!: to .or? .ith
chi:r!# .i >! r!A9ir!:= R!;!r!#c!s .i #ot >! %cc!"t!: ;ro/ r!%ti<!s or "!o"! .riti#$ so!2 i# th! c%"%cit2
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,lease state the conte<t in )hich this person is !no)n to yourself:
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,lease state the conte<t in )hich this person is !no)n to yourself:
B
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B DECLARATION C* APPLICANT
. understand that appointment to this post is su+=ect to a satisfactory 0nhanced Criminal Records 8ureau
disclosure . also understand that, under the terms of the Reha+ilitation of 5ffenders Act 19C4 >0<ceptions 5rder
19CD, and su+se*uent amendments?, . am re*uired to disclose any record . may ha-e of criminal con-ictions,
cautions and +indEo-ers, including those regarded as Fspent" and to attach details of the sameG
(a-e you a record of criminal con-ictions, cautions or +indEo-ersH 9es >details attached? 2o
G ,lease note information a+out criminal con-ictions, cautions and +indEo-ers )ill remain confidential +ut )ill +e made a-aila+le
to the panel for consideration if your application is other)ise deemed )orthy of shortElisting
. declare that . am not on /ist 99, or dis*ualified from )or!ing )ith children, or su+=ect to any sanctions imposed +y
a regulatory +ody >eg the :eneral %eaching Council?
. understand that under the terms of the .mmigration, Asylum and 2ationality Act 200' should . +e shortElisted for
the post for )hich . am applying, . )ill pro-ide for the go-erning +ody, as employer, an original documentG sho)ing
my entitlement to )or! in this country
GAccepta+le documents include your 2ational .nsurance card, a +irth certificate issued in the 37 or 0ire, a ,4D from your
pre-ious employer, a -alid passport, or any rele-ant authorisation allo)ing you to )or! in this country
. appreciate that . must declare any family or close relationship )ith a mem+er of the school;s :o-erning 8ody, an
employee of the school or senior official of the local education authority )hich has responsi+ility for the school .
understand that failure to disclose such a relationship may result in my dis*ualification
. certify that all information gi-en +y me on each section of this form and in supporting documents is correct to the
+est of my !no)ledge and +elief, that all *uestions ha-e +een fully and accurately ans)ered, and that . possess all
*ualifications )hich . claim to hold and )ill produce e-idence of the same . ac!no)ledge that . ha-e read,
understand and )ill comply )ith the 2otes to Applicants )hich accompanied this application form
. understand that my name )ill +e )ithdra)n from the list of candidates if, prior to appointment, . am found
!no)ingly to ha-e omitted or concealed any rele-ant fact, and . ac!no)ledge that such disco-ery su+se*uent to
appointment is li!ely to lead to my dismissal )ithout notice and, )here appropriate, referral to the police
. here+y consent to the processing of sensiti-e personal data, as defined +y the 6ata ,rotection Act 199I, in-ol-ed
in the consideration of this application
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4
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ADDITIONAL INFORMATION -CONFIDENTIAL3 - This s!ctio# o; th! ;or/ s!!?s %::itio#% i#;or/%tio#
"!rti#!#t to 2o9r %""ic%tio#= It .i >! r!/o<!: >!;or! shortisti#$ %#: .i #ot >! s!!# >2 %#2 /!/>!rs o; th!
s!!ctio# "%#!= Acc!ss to it .i >! i/it!: to st%;; i#<o<!: i# %:/i#ist!ri#$ th! %""oi#t/!#t "roc!ss .ho #!!:
%cc!ss ;or !A9% o""ort9#iti!s /o#itori#$ or to t%?! %:/i#istr%ti<! %ctio# >%s!: 9"o# th! i#;or/%tio# "ro<i:!:
!=$= Occ9"%tio#% H!%th r!;!rr%
Positio# %""i!: ;or:
%itle: 1irst name: $urname:
6ate of +irth:
Are there any reasona+le ad=ustments you )ould li!e us to ma!e to ena+le you to participate fully and fairly in the
recruitment processH
9es 2o
.f 9es, please gi-e details:
D
$680@A,,$$@5ct 2010
E5UAL OPPORTUNITIES MONITORING - .! .ish to /o#itor co#ti#9o9s2 -i# th! strict!st co#;i:!#c!3 th!
"ro$r!ss o; o9r EA9% O""ort9#iti!s Poic2= P!%s! h!" 9s >2 $i<i#$ th! ;9!st "ossi>! %#s.!rs to th!
A9!stio#s >!o.=
S!1: M 1 A$!: 20E29 B0EB9 40E49 D0ED9 '0E'D
. consider myself to +e disa+led )ithin the meaning of the 6isa+ility 6iscrimination Act 199D
P!%s! i#:ic%t! 2o9r c9t9r%/!th#ic ori$i#s
%his information is included as part of the duty of the school to promote race e*uality and to ensure e*ual
opportunities for all staff and is recommended +y the Commission for Racial 0*uality >)))crego-u!?
White
8ritish
0nglish
$cottish
&elsh
5ther: please )rite in
.rish
Any other &hite +ac!ground: please )rite in
Black, Black British, Black English, Black Scottish or Black Welsh
Cari++ean
African
Any other 8lac! +ac!ground: please )rite in
Asian, Asian British, Asian English, Asian Scottish or Asian Welsh
.ndian
,a!istani
8angladeshi
Any other Asian +ac!ground: please )rite in
Mixed
&hite J 8lac! Cari++ean
&hite J 8lac! African
&hite J Asian
Any other Mi<ed +ac!ground: please )rite in
Chinese, Chinese British, Chinese English, Chinese Scottish or Chinese Welsh or other ethnic group
Chinese
Any other +ac!ground: please )rite in
Prefer not to state
Put a cross here if you prefer not to state your ethnic group
'
$680@A,,$$@5ct 2010
Not!s to %""ic%#ts
8efore signing this form please chec! that e-ery section has +een completed
%he form should +e returned as instructed in the details of the post
0nclose a stamped addressed en-elope if you )ish us to ac!no)ledge your application
9ou are reminded that this is an application form for a post in a Church of 0ngland@Church in &ales 4oluntary
Aided school or a 1oundation school in )hich the :o-erning 8ody is the employer .f you are appointed the
Contract you )ill +e as!ed to sign )ill include the follo)ing clause:
o As an employee at a Church of 0ngland@Church in &ales school you are re*uired to ha-e regard to the
Christian character of the school and its 1oundation and to underta!e not to do anything in any )ay
contrary to the interests of the 1oundation
%he successful applicant )ill +e re*uired to pro-ide an 0nhanced 6isclosure from the CR8
Details of referees
5ne referee should +e your current or most recent employer .f you are not currently )or!ing )ith children +ut
ha-e done so in the past, a reference )ill +e re*uired from the employer +y )hom you )ere most recently
employed in )or! )ith children
%he school )ill see! references on shortElisted candidates, and may approach pre-ious employers for information
to -erify particular e<perience of *ualifications, +efore the inter-ie)
.f you are currently )or!ing )ith children, on a paid or -oluntary +asis, your current employer )ill +e as!ed a+out
disciplinary offences relating to children, including any penalty )hich is time e<pired and )hether you ha-e +een
the su+=ect of any child protection concerns, and if so, the outcome of the en*uiry or disciplinary procedure .f you
are not currently )or!ing )ith children +ut ha-e done so in the past, the rele-ant pre-ious employer )ill +e as!ed
a+out those issues
References from relati-es or friends )riting solely in the capacity of friends )ill not +e accepted
C
$680@A,,$$@5ct 2010