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117/04/07

www.dudleycol.ac.uk

Application for Employment


Name
(forename first)

Candidate Number
(for Office use only)

Post Applied for

Post Reference

Closing Date

Please return this application form to:


Human Resource Development Department,
Dudley College ,The Broadway,
Dudley,West Midlands. DY1 4AS
Fax: 01384 363444

Putting learners and our community at the


heart of all we do
Dudley College Application for Employment

Candidate Number (Office use only)

ADVICE ON COMPLETING THIS FORM


Please take great care in completing this form since the decision to shortlist for interview will be based entirely on the information
you provide.
All posts have a job description and person specification which lists the skills, knowledge and experience needed. Make sure you have
both the job description and person specification before you complete the form; unless you clearly demonstrate in your application
how you meet the requirements specified you may not be shortlisted.
The form will be photocopied, so you should use black or blue ink.
When you complete Section 5 you may wish to include experience/training/skills that you have obtained through employment, or at
home, or within the community, which meet the requirements of the job description and person specification. In addition, you are
invited to include within this section any other relevant information about yourself not included elsewhere.
Pages 1, 6 and 7 of the form will be separated before shortlisting; the shortlisting panel will make their decisions on pages 2 to 5
without access to any personal information.
The Application Form is also available in other formats, e.g. Braille. Should you require any other format or any assistance in
completing the form, please contact the Human Resource Development Department.

You should therefore not include a curriculum vitae with your application.

Application for the Post of Post Reference No

Section 1: Personal Details


FULL NAME: Surname Other Names

Mrs/Miss/Ms/Mr/Dr/Other Previous Surname

Home Address

Post Code

Correspondence Address (if different from above)

Post Code

TELEPHONE: Home TELEPHONE: Business Daytime


(only if we may contact you on this number)

TELEPHONE: Mobile E-mail address

Date of Birth National Insurance Number

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Candidate Number (Office use only)

Section 2: References
Please give full name and address of two referees who will be able to provide a reference on your professional capability and
suitability for the post. One of them should be your present or most recent employer.

REFEREE 1 REFEREE 2
Name Name

Job Title Job Title

Address Address

Post Code Post Code

Tel No. Tel No.

Fax No. Fax No.

Email Address Email Address

Referee’s Relationship to you Referee’s Relationship to you

May we seek reference prior to interview? Yes No May we seek reference prior to interview? Yes No

Section 3: Current Post A


Post Held Department

Name of Employer

Address of Employer

Postcode

Date Appointed to post Basic Salary

Additional Allowance(s) Grade

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Dudley College Application for Employment

Candidate Number (Office use only)

Give brief details of duties and responsibilities of your present or most recent post:

Reason for leaving?

How much notice are you required to give to your present employer?

DETAILS OF PREVIOUS EMPLOYMENT


If part time, please state number of hours per week.
PLEASE LIST MOST RECENT FIRST.

Annual
Employer Name and Address Job Title Reason for Leaving
Salary
B

Please note: You will be required to provide details of all periods of employment including dates from and to if successfully appointed.

Do you have a full driving licence? Yes No Do you have regular use of a Yes No
car/motorcycle?

Do you hold a current First Aid At Work Certificate? Yes No

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Section 4: Secondary/Further Education and Examination Results


QUALIFICATIONS (please specify full-time, part-time, sandwich courses etc.)
PLEASE LIST MOST RECENT FIRST.

Expected
Grade
School/College/University FT/PT Qualifications Obtained Achievement Date
Achieved
(MM/YY)
1

Please note: You will be required to provide evidence of all relevant qualifications if successfully appointed

DETAILS OF MOST RECENT TRAINING COURSES ATTENDED


Course Organising Body

PROFESSIONAL MEMBERSHIP
Please give details of any professional membership you currently hold:

Are you a qualified teacher? Yes No


If you hold a DfES number, please state below:
If Yes, please indicate qualifications held:

BEd Will this be your first teaching post? Yes No


PGCE
Cert Ed Special Subjects Offered:
7407 Stage 3
7407 Stage 2
7407 Stage 1
Other

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Dudley College Application for Employment

Candidate Number (Office use only)

Section 5: All Posts


Please summarise the reasons for your application and provide details of how you meet the requirements of the job description
and person specification.You should refer to the criteria outlined in the job description and person specification sent with this
form; these will be used in the selection process.You can demonstrate your suitability for the post using examples from previous
work, vocational and voluntary experience.This information can be provided on a separate sheet if you wish; please make sure it
is securely attached to the form.

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Section 6: Equality Monitoring


GENDER: Male Female

DISABILITY: Do you have a disability or condition that you would like the college to know about? Yes No

If yes, is there any assistance you would like the College to provide at interview or for you to carry out this job?

If you wish to take advantage of the law relating to disability and of the College’s policy regarding the employment of people with
disabilities you must advise the College of your disability. Please give details of your disability:

Are you currently eligible to work in the UK? Yes No

To which of the following groups would you say you belong? (Please tick one box only)
African Indian Other
Bangladeshi Mixed White/Asian Pakistani
Caribbean Mixed White/Black African White British
Chinese Mixed White/Black Caribbean White Irish

FOR MONITORING AND SALARY ASSESSMENT


Dates of previous employment as listed in Section 3 (page 3). PLEASE LIST MOST RECENT FIRST.
Dates employed
Employer Name
(MM/YY) to (MM/YY)
A

Dates of each of the qualifications listed in Section 4 (Page 4). PLEASE LIST MOST RECENT FIRST.

School/College/ Date gained


Qualification
University (MM/YY)
1
2
3
4
5

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Dudley College Application for Employment

Candidate Number (Office use only)

Section 7: Other Information


Are you related or known to any member of Dudley College of Technology Corporation or member of staff? Yes No
Name of Person Relationship
(A candidate who fails to disclose such a relationship shall be disqualified from the appointment and if appointed could be liable to dismissal without notice)
ANY CANVASSING WILL DISQUALIFY CANDIDATES

Please state where you saw the post advertised (include newspaper title, journal title, website etc)

Section 8: Disclosure of Criminal Background


Successful candidates will be required to undertake an enhanced Criminal Records Bureau (CRB) Disclosure check.

You are asked to give details of any convictions including those which for other purposes are 'spent' under the provision of the Act. If
you are offered employment, then any failure to disclose such convictions could result in dismissal or disciplinary action by the
College. All convictions must be included. If you have no convictions then please write 'none'.

Date

Police Convictions, Cautions, Reprimands and Final Warning

Sentence

Declaration
I declare that the information given above and in any supporting documents is true and that nothing has been omitted that would
affect the application. I understand that any false or misleading information given in this application may render my contract of
employment, if I am appointed, liable to termination. I agree that information provided on this application form can be used for data
processing as defined in the Data Protection Act 1998.

Signed Date

Dudley College actively promotes equality and celebrates diversity.


Thank you for completing this application form.

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