Application Form
Application Form
Application Form
Your rights.
You can see your rights in relation to the application by visiting https://ico.org.uk/your-data-matters/.
You may withdraw your consent for us to process your data at any point in the process prior to an acceptance of
employment and we have 28 days to comply with the request.
Retention
Unsuccessful candidates’ application forms will be destroyed after 6 months.
Successful applicants will be provided with a fully informed employee privacy notice alongside their contract. The
information provided on this form will be stored with the successful applicant’s personnel file. This is kept in line with
the School’s record retention schedule. This can be found on the School website.
Signature – I certify that to the best of my knowledge, the information given on this form is correct and true. I
understand that my application may be rejected or that I may be dismissed for withholding relevant details or giving
false information.
I also understand that the information I have provided may be subject to checking. I have not canvassed an Elected
Member/employee of the City Council, either directly or indirectly in connection with this application and I will not do so.
By signing this notice, I explicitly consent for my personal information to be processed by the School in line
with the recruitment process in relation to this application only. I understand I can withdraw my consent to use
my personal information in this application at any point prior to accepting an employment offer.
Signature: Date:
Please complete in black ink
Post Code:
Daytime Telephone Number: Evening Telephone Number:
Mobile Telephone Number:
E-mail Address:
Please indicate if you are happy to receive correspondence via your email address, e.g. invite to interview letter? Yes No
National Insurance Number:
Are you eligible to work in the UK? Yes No Do you require a work permit? Yes No
Are you currently, or have you previously been, employed by Coventry City Council? Yes No
If yes, please provide dates from and to and reasons for leaving (if applicable):
Date from: Date to:
Reason for leaving:
Please provide two referees, one of whom must be your current or most recent employer. Family members may not be used as
referees. Any offer of appointment will be subject to references which are satisfactory for our purposes.
First Reference (Current or most recent employer) Second Reference
Name: Name:
Job title: Job title:
Organisation: Organisation:
Address: Address:
Postcode: Postcode:
Telephone No: Telephone No:
E-mail Address: E-mail Address:
Relationship to you: Relationship to you:
Do you wish to be consulted before this referee is approached? Do you wish to be consulted before this referee is approached?
Yes No Yes No
Notice Required:
Telephone number:
Employment history
References may be sought from your previous employers. Please indicate if you wish to be consulted before they are
approached:
Yes No
Date from: Date to: Name and address of Job Title: Reason for Leaving:
employer:
Relevant education and qualifications
Relevant qualification: Result/grade: Date obtained:
Relevant training
Date: Course title: Organising body:
Membership of relevant professional bodies:
Name of professional body: Type of membership: Date of membership: Membership number:
If yes, please state the number of hours you will be working in other jobs in this box
This information is required to ensure we comply with Working Time Regulations.
Are you related to a Councillor, School Governor or employee of this organisation? Yes No
Relationship to you:
If you fail to disclose such information, you may be disqualified from consideration or, if appointed, liable to dismissal without notice. Canvassing of
Councillors, Governors or employees in relation to this application will disqualify any applicant.
Convictions/Disqualifications
If you have a conviction, which is not spent under the terms of the Rehabilitation of Offenders Act 1974, you must indicate below.
However, if you are applying for a post which requires a DBS check all convictions remain unspent and you must declare them.
I have convictions or disqualifications which are unspent: Yes No
If yes, please give details and dates of any unspent* criminal convictions, disqualifications, cautions or driving offences:
*Please note unspent convictions will only be taken in to account if thought relevant to the job and would preclude you from being considered.
Disability
Do you consider yourself to have a disability within the terms of the Equality Act 2010?
Yes No
This organisation has made a commitment to improve the employment opportunities for people with disabilities and has, therefore,
undertaken to guarantee to interview all applicants with a disability who meet the essential requirements of the job as contained in the
person specification.
Please specify any arrangements we can make to assist you if you are invited to attend for interview/assessment (e.g. wheelchair
access, BSL interpreter or information in alternative format):
Declaration
I confirm that the information contained in this application is, to the best of my knowledge, correct and understand that my application
may be rejected or that I may be dismissed without notice for withholding, or giving false information. I also give my consent to the
processing of data contained or referred to in this application in accordance with the Data Protection Act 1998 and subsequent
legislation.
Signature: Date:
Please note: If you return this form by e-mail, your signature confirming the above will be requested if you are invited to attend an
interview. If you are printing this form out and returning it by post, please sign in black ink before returning it.