CONFIDENTIAL EMPLOYMENT PERSONAL DETAILS AND MONITORING FORM

Please return completed forms to: Human Resources Department, Tresham Institute, Windmill Avenue, Kettering, Northants, NN15 6ER
Post applied for: Post No: Applicant No: (office use only)

THE INFORMATION ON THIS FORM WILL BE TREATED AS STRICTLY CONFIDENTIAL AND WILL BE USED FOR MONITORING PURPOSES WHERE APPLICABLE. IT WILL NOT BE AVAILABLE TO MEMBERS OF THE SELECTION PANEL. Please complete both sides of this form carefully and clearly. This form will be separated from your application form prior to shortlisting. The information from this form will be processed and used in accordance with the Data Protection Act for monitoring purposes and, if you are a successful candidate, in connection with the management of, and relationship with you as an employee. PERSONAL DETAILS
Title: Surname/Family Name: Forenames:

Home Address:

Telephone Numbers: Daytime/Work No: Evening/Home No: Mobile No: Email address:

Post Code: NI No: DfES No:

EQUAL OPPORTUNITIES IN EMPLOYMENT MONITORING
Tresham Institute, as an equal opportunity employer, intends that no job applicant or employee shall receive less favourable treatment because of their sex, marital status, race, colour, nationality, national origin, ethnic origin, disability, religion or sexual orientation, nor be disadvantaged by any other condition or requirement which cannot be shown to be justifiable. In order to ensure the successful development of this policy in relation to the recruitment and selection of staff, all applicants should fill in the appropriate details (by ticking the relevant boxes) below. GENDER: DATE OF BIRTH: consider them on their abilities.
Please tick appropriate box

Male AGE:

Female

NATIONALITY/COUNTRY OF ORIGIN: MARITAL STATUS:
Widowed or Divorced would normally tick "single"

Single

Married

DISABILITY - The Institute will interview all applicants with a disability, that meet the minimum criteria for the vacant post and Do you consider yourself to have a disability? If YES, please indicate the nature of your disability: Yes No

Please state what personal facilities you are likely to need if appointed to the post:

Please state here what facilities or support you would require to assist you at interview:

ASYLUM & IMMIGRATION ACT

Are you currently eligible for employment in the UK? Documentary evidence will be required. Do you need a work permit to work in the UK? Are you registered with the Home Office under the Workers Registration Scheme?

Yes Yes Yes

No No No

ETHNICITY (please tick the appropriate category or use the space provided to provide your own definition) Asian or Asian British - Bangladeshi Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - any other Asian background (please specify) Black or Black British - African Black or Black British - Caribbean Black or black British - any other Black background (please specify) Chinese Mixed - White and Asian Mixed - White and Black African Mixed - White and lack Caribbean Mixed - any other Mixed background (please
specify)

White - British White - Irish White - any other White background (please
specify)

Any other (please specify)

PREVIOUS SURNAME: ……………………………………………………………….. (This information may be
required in order to check the qualifications etc of shortlisted/successful applicants and to assist where necessary with references.)

DISCLOSURE OF CRIMINAL CONVICTIONS
Tresham Institute is required to ensure that all staff working at the college who have regular contact with children, young people and vulnerable adults, are checked prior to commencing work. This applies primarily to posts within the Curriculum area, Learning Resources and Student Services. Applicants applying for posts within these areas are required to declare any current and previous criminal convictions (including spent ones). If the post that you have applied for falls within this category, this will be stated on the job advertisement and a copy of the Institute's policy on the Rehabilitation of Offenders will be enclosed with this application form. Possession of a criminal record will not necessarily be a bar to obtaining a position. The successful applicants for all posts within the Institute will be checked against the Department for Education and Skills List 99 database which contains details of people whose employment has been barred or restricted by the Secretary of State for Education and Skills under the terms of the Education (Restriction of Employment) Regulations 2000 and previous regulations. A copy of the Institute's Code of Practice is available on request from the HR Department.

To be completed by all applicants: Do you have any current convictions or criminal charges pending? If Yes, please give details: Yes No

To be completed by applicants for posts which are exempt from Section 4(b) of the Rehabilitation of Offenders Act. Any failure to disclose such convictions could put your employment at risk. Do you have any criminal convictions (including spent Yes No convictions)? If Yes, please give details below or on a separate sheet How did you find out about this job?
(enter name of publication where advertisement seen)

Are you a relative, partner or close friend of any member of the staff or Corporation? If Yes: Name: Relationship:

DECLARATION
All or parts of the information on this form may be stored on computer files and used for the purpose of personnel administration. Such use will be subject to the provisions of the Data Protection Act 1998. By signing the form it is implied that you agree with these terms. To the best of my knowledge the information given on this form and within the application form is correct. I understand that canvassing or giving false information will disqualify my application, or lead to the termination of any offer of employment. I also understand that should my application proceed to interview/offer of employment, I will be required to produce supporting documentation as evidence of my qualifications, previous experience, eligibility for employment and, where applicable, criminal convictions. Email applications: If you are sending your application form by email, please tick the box below (as a substitute to your signature) to confirm that you agree to the above declaration. Please note that when you submit this form by email the information that is sent to us will not be encrypted. If invited for an interview, you will be asked to sign this page. Email substitution of signature

Signature

Date

Post applied for and Reference Number:

Candidate Number:
(office use only)

Applicants should complete all sections of the application form in type or black ink. Do not leave sections blank or refer the reader to your CV, although Curriculum Vitae may be enclosed to provide additional information. EDUCATION AND QUALIFICATIONS (please list most recent first)
Name of School, College or University Secondary Qualifications gained, including subject areas Grades

College/University

Other Training/Short Courses (within last 5 years)
Organisation Course and Subject

Professional Membership (if you are a member of any professional body(ies) please give details below)
Professional Body Level of Membership

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WORK HISTORY
Present/Last Employer's name and address: Position held: From: Salary: Reason for Leaving: To: Hrs per week:

Notice required: Duties, responsibilities, major achievements etc:

Previous Work Experience (this may include periods spent at home with family or other commitments)
From To Employer's Name Position held and duties Reason for Leaving

PLEASE PROVIDE EXPLANATIONS FOR ANY GAPS IN YOUR WORK HISTORY

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ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION You are invited to provide further information in support of your application. Please make full use of this section and continue on additional sheets if necessary. Make sure that you refer to the Person Specification within the Job Description, and also include: The reason why you are applying for this post; Key responsibilities and achievements in your present or most recent job which are relevant to this application; Details of any relevant interests or activities; The reasons why you feel you would be successful in this post.

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HEALTH (please note that all salaried appointments are subject to satisfactory medical clearance) Are you suffering, or have suffered, from any major illness/industrial injury? How many days have you been absent from work due to sickness in the last 2 years? How many periods of sickness does this represent? Is this your usual level of sickness? YES / NO
delete as applicable

YES / NO
delete as applicable

EMPLOYMENT REFERENCES Please give details of two people we may approach for references, one of whom should be your present/last employer. Referees should be employment related, not personal referees.
Title & Name: Position: Company: Address: Title & Name: Position: Company: Address:

Tel No: Email address: May we obtain a reference prior to interview? YES / NO

Tel No: Email address: May we obtain a reference prior to interview? YES / NO

delete as applicable

delete as applicable

INTERVIEW AVAILABILITY (please indicate any imminent dates/times you are unavailable for interview) Date Times ie morning/afternoon/all day

If appointed, do you have any business or other interests which would conflict with the duties of this post? Do you hold a current driving licence? Do you have use of a car?

YES / NO YES / NO YES / NO
delete as applicable

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