Application for employment:

Please complete and return by email to personnel@ke6n.ac.uk

Vacancy details
Post applied for :
Personal details

Surname Forenames (s)

Permanent address Preferred title (ie, Mr/Mrs/Ms/Miss/Prof/Dr)

Post Code
Telephone (daytime) Telephone (evening)

Temporary address and dates (if applicable) E-mail

Are you legally eligible for employment in the UK? Yes/NO (Please delete as appropriate)
Do you require a work permit? NO/YES (Please delete as appropriate)
If yes how long is your current work permit valid?

National Insurance Teacher’s Reference No:

Number: (if applicable):

Referees
Please name two people who may be approached for a reference connected with your work experience. One of
these must be your present, or most recent, employer. References will be taken up if you are invited for interview.
If you do not wish any referee to be contacted at this stage, please place an ‘X’ in the relevant box.

First referee Second referee

Name Name

Address Address

Post Code Post Code

Telephone Telephone
E-mail E-mail
Position/Post title Position/Post title
 Post Applied for:
(internal use only)

Present employment (list current / most recent employer first)

Name and Address: Post/Title:

Salary:
Other allowances:
Date of commencement:
Period of notice:

Reason for change from current employer:

Brief description of duties:

All previous employment (most recent first, including unpaid and voluntary work)

From To Salary or Reason for

mth/yr mth/yr Employer Post/Title Grade leaving

Availability for interview

Please indicate any dates when you will not be available for interview during the weeks following the
closing date.
Education and training

From To School, College, Polytechnic, University Qualification obtained Date

mth/yr mth/yr attended including grade or stage passed

Details of other courses attended / Recent CPD

From To Course title and organising body Subjects Length of

mth/yr mth/yr course

Membership of professional bodies

Name of professional body Present grade or Was entry gained through If yes, please give
membership examination? date
 Relevant experience and skills
Please give details, in no more than 500 words/1 side of A4 why your previous experience, personal
skills and values make you a good candidate for this post.

(If necessary, please continue on a separate sheet)

 PROTECTION OF CHILDREN: Disclosure of Criminal Background

The College is committed to safeguarding and promoting the welfare of our students and expects all staff and
volunteers to share in this commitment. As a “Regulated Activity Institution” the College will check the Criminal
background of those employees presently or potentially give them access to young adults. As a consequence you
will be required to provide details of any criminal record, and to give permission for checks of convictions and
cautions to be made via an Enhanced Criminal Records Bureau disclosure check, before the commencement of
employment with the College.

HEALTH AND MEDICAL DETAILS

Do you consider yourself to have a disability as defined in the ‘Equality Act 2010’ NO/YES
Prior to formal appointment, the successful candidate will be required to complete a confidential statement of
medical history and may be required to undergo a medical examination.

Declaration

This form should be returned to:

I certify that the information given on this form is correct.
I understand that any wilful omission or falsification may
People Team
lead to the disqualification of this application or dismissal
King Edward VI College
if appointed to the post applied for. King Edward Road
Nuneaton CV11 4BE
E:mail: personnel@ke6n.ac.uk
Signed
_______________________________________________

Date
_____________________

The General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679) and Data Protection Act 2018
We will hold and process any personal data, including sensitive (special category) personal data, relating to you in accordance with
our legal obligations, in the manner set out in the Privacy Notice for Staff, which can be found here
https://kecnuneaton.ac.uk/wp-content/uploads/2018/05/Staff_Privacy.docx The Privacy Notice for Staff does not form a
part of your contract of employment.
NOTICE TO APPLICANTS:

CONVICTIONS AND ‘SPENT’ CONVICTIONS OF A CRIMINAL NATURE

You will appreciate that the organisations must be particularly careful to inquire into the character and
background of applicants for appointments to posts involving contact with children under the age of 18. It
is therefore essential that, in making your application, applicants declare any pending criminal
prosecutions they may have as well as any spent criminal convictions, cautions, reprimands and final
warnings as defined under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. The only
exception to this requirement is that applicants do not need to disclose any ‘protected’ cautions or
convictions as defined by The Rehabilitations of Offenders Act 1974 (Exceptions) Order 1975
(Amendment) (England and Wales) Order 2013. Guidance and criteria about ‘protected’ spent convictions
and cautions can be found on the Disclosure and Barring Service website. Only when the conviction is
relevant will criminal records be taken into account for recruitment purposes. The fact that conviction(s)
have been reported against you will not necessarily debar you from consideration for this appointment.

You must, therefore, answer the question at the foot of this notice.

In accordance with the recommendations of the Home Office, successful candidates for all posts where
there is to be contact with children, will be the subject of a request to the Warwickshire Constabulary for a
search by the Criminal Records Office via the Disclosure and Barring Service, regardless of the answer
given to the question concerning convictions.

Failure to answer the question on this notice may prevent further consideration of your application.
Acceptance of an offer of appointment will be deemed to be acceptance that such an investigation may
take place.

Applicants are warned that providing false information is a disciplinary matter and may result in summary
dismissal.

A copy of this notice may be sent to your referees.

a) Do you have any cautions (including final warnings or reprimands) or convictions which are not
‘protected’ as defined by the Exceptions Order 1975 (as amended by the 2013 Exceptions Order) to the
Rehabilitations of Offenders Act 1974?
NO/YES

b) If ‘Yes’ please give brief details of the offence, including the date of the conviction. These must be
submitted in a separate envelope marked ‘Confidential Disclosure’.

Signed………..……………… Date ………………………………………….

Post applied for …… ………………………………………………………….

Equality & Diversity Monitoring form

The information given on this form is confidential and is purely for the purpose of monitoring equality and
diversity to ensure all groups are treated fairly. This form will be retained by the Personnel Department
and will not be used by the interview panel when making the appointment. Any candidates with a
disability will be guaranteed an interview, if they meet the basic requirements of the post.
Please complete and return in a separate envelope, together with your application form, if making postal
application

Post applied for:

Age: 16-25 26-34 35-44 45-54 55-64 65+
Gender: Male Female Prefer not to say
Gender Identity (if Do you present full or part time in a gender that differs from the
appropriate) gender assigned to you at birth
Yes No Prefer not to say

Ethnic origin: Please tick against one of the following: (The classification below of black and
minority ethnic (BME) groups is in line with the 2001 census breakdown.

Asian or Asian British Mixed

Bangladeshi White and Black Caribbean

Indian White and Black African
Pakistani White and Asian
Any other Asian background Any other mixed background
Please specify below if you wish....... Please specify below if you wish.......
........................................................... ......................................................

Black or Black British White

African British
Caribbean English
Any other Black background Irish
Please specify below if you wish....... Scottish
........................................................... Welsh
Any other White background
Please specify below if you wish.......
......................................................

Chinese or Other ethnic group Prefer not to say

Chinese
Any other
Please specify below if you wish.......
...........................................................
Disability: Please tick against one of the following:
Do you consider yourself to have a disability under the Equality Act 2010?
In the Act, a person has a disability if:

they have a physical or mental impairment that has a substantial and long-term adverse effect
on their ability to perform normal day-to-day activities

For the purposes of the Act, these words have the following meanings:
'substantial' means more than minor or trivial

'long-term' means that the effect of the impairment has lasted or is likely to last for at least
twelve months (there are special rules covering recurring or fluctuating conditions)

Yes No Prefer not to say

Please describe the nature of your disability

This information is provided for monitoring purposes only – if you need any reasonable
adjustments in the interview process please advise and these can be arranged separately.

Religion or belief: Please tick against one of the following

No religion Jewish

Baha’i Muslim

Buddhist Sikh

Christian Other
Please specify below if
Hindu you
wish………………………
Jain …..
……………………………
…

Prefer not to say

Sexual Orientation: Please tick against one of the following

Bisexual Gay Man/Homosexual

Gay Woman/Lesbian Heterosexual/straight

Prefer not to say

Please indicate which media source you saw the position advertised in.

Thank you for completing this form