ࡱ>  bjbjss h;,,$$$$$$$$$t^%$?L*.@.@.@.@._1j1$1KKKKKKK$OyRhK-$31^_133K$$@.@.K6663R$8@.$@.K63K66rH$J@.83vI"KL0?LISt4SDJS$J2hi2J62<2222KK5222?L3333S222222222, L#:  APPLICATION FORM Vacancy Details Please complete and note the Post Title and Job Reference Number of the vacancy which you are applying for, as you will be asked for this should you contact us about your application. Job Reference No. Post Applied For. Media Where did you see this post advertised? Personal Details This information will be used when we communicate with you about your application and will form part of your employment record should you be the successful applicant. Surname aFirst Names bTitle cPrevious NameaAddress Line 2 >Postcode dAddress Line 3 \Address Line 4 /Mobile No.Home No.Fax No.Work No.Home e-mail addressWork e-mail addressPreferred method of communication  For HR Department Use Only HR Administrator to allocate a candidate reference number and remove all monitor documents from the application form prior to sending to shortlisting panel manager. Candidate Reference No Date ReceivedLogged on HR Database   Application Form Current EmploymentPlease give details about your current employer, or last employer if you are not presently employed, along with a brief description of your duties. This could include for example, tasks, objectives, and responsibilities. Please note: We may ask your employer to verify the details you provide on your application form.Dates of service From To Name & address of employerPosition held & brief outline of dutiesReason for leavingCurrent salary (pa)Notice Period Previous EmploymentPlease give details of all your previous employment starting with the most recent first. Please note: If you are shortlisted for interview and assessment, LutubeƵ reserves the right to verify the information you have provided with any of your previous employers. Dates of service From To Name & address of employerPosition held & brief outline of dutiesReason for leaving Academic and Professional Qualifications Please give us details of your academic and professional qualifications. These can include details of comparable overseas qualifications. Please note: You will be required to provide your original documents as proof of any relevant qualification at the job interview and assessment should you be shortlisted. LutubeƵ also reserves the right to verify the information that you have given with the educational establishments. Academic institution AttendedDate attainedSubjects (if applicable)Qualifications/GradeProfessional Development Courses Attended (in the last 5 years)Please give us details of any relevant professional development / Training courses that you have attended in the last five years. Please note that you can include details of comparable overseas training that you have attended in the last five years.Dates attendedCourse titleOrganising bodyMembership of Professional Bodies, Boards or CommitteesPlease provide details of any professional bodies that you are a member of and details about your membership. Please note: You may be required to verify this information if you are shortlisted for interview and assessment. Supporting Statement & EvidencePlease tell us how you meet the job requirements detailed in the person specification, which are highlighted as being measurable by the application form. This will include any relevant experience, knowledge, abilities and skills that you have. You may wish to refer to the Completing Your Application Form guide. Give as much evidence as you can in support of each of the job requirements. You can include examples from paid work and relevant voluntary work, community activities, domestic or family experience or details of relevant training or short courses. Supplementary sheets should be attached securely and marked clearly with your name, sheet number and the vacancy reference number. Please comment below on how you meet the criteria as detailed within the person specification entitled relevant experience.  Please comment below on how you meet the criteria as detailed within the person specification entitled relevant knowledge / skills & aptitudes.  Please comment below on how you meet the criteria as detailed within the person specification entitled special requirements. Do you hold a full UK Driving Licence ( Yes ( No  Other EmploymentPlease give details of any other paid employment you intend to continue if offered a position within LutubeƵ. This information is required to: ensure working hours do not exceed the requirements of the Working Time Directive. ensure that any appointment with the College will not create a conflict of interest within your professional or personal life. LutubeƵ reserves the right to notify you of any conflicts of interest and any offer of employment would be dependant upon this conflict ceasing. Employing / Voluntary Organisation Job title / Role UndertakenHours per weekWeeks per year  References Please give details of two people who are prepared to act as referees for you. One of these must be your current or most recent employer. If you have just left full-time education you should provide details of your course tutor. You should also provide details of the dates when you worked with them or they were your course tutor. Please note: LutubeƵ does not accept references from friends and family members of the applicant. Referees will automatically be contacted for applicants shortlisted to attend interview and assessment, unless your application has been clearly marked to show that an approach should not be made. You should ensure that your referees are in a position to respond promptly. Please note: LutubeƵ reserves the right to request a reference, or to contact any of your employers or educational establishments, in addition to the two referees you have nominated in your application. Title jTitle tForename kForename uSurname lSurname vPosition mPosition wOrganisation nOrganisation xProfessional Relationship to applicantProfessional Relationship to applicantHow long have you known the referee yearsHow long have you known the refereeyearsAddress Line 1 oAddress Line 1 yAddress Line 2 pAddress Line 2 zAddress Line 3 qAddress Line 3 @Address Line 4 rPostcode sAddress Line 4 #Postcode ?TelephoneTelephoneFax NoFax No.E-mail addressE-mail addressMay we contact this referee prior to interview? Yes NoMay we contact this referee prior to interview? Yes No Disability: Reasonable Adjustments / Arrangements For Interview Please tell us about any access requirements or reasonable adjustments you require in order for you to fully participate in the selection process.Criminal Records PLEASE COMPLETE EITHER SECTION A OR SECTION B. The Rehabilitation of Offenders Act 1974 ensures re-offenders who have not re-offended for a period of time since the date of their conviction are not discriminated against when applying for jobs.SECTION ADo you have any unspent criminal convictions and whether any police investigations are currently being processed following allegations made against you.  Yes No SECTION BDue to the nature of your role, the post that you are applying for is exempt from the Rehabilitation of Offenders Act 1974. You are therefore not entitled to withhold information about convictions, warnings, cautions and reprimands which for other purposes would be regarded as spent under the provisions of the Act. Although cautions, reprimands and final warnings are not considered to be criminal convictions, these will be considered by us in relation to the post that you are applying for.Do you have any convictions, warnings cautions and reprimands Yes No LutubeƵ will use Part V of the Police Act 1997, to obtain a criminal record check for prospective employees. These checks are known as disclosures and are carried out by the Disclosure and Barring Service (DBS).I give my consent to a disclosure to be carried out by the DBS if I am selected for appointment and understand that my appointment is subject to a DBS Disclosure.SignatureDateNote: If you are convicted or receive a warning, caution or reprimand during the application process, you must inform the HR representative of the details. A separate declaration form requesting details of any offences may be sent to shortlisted candidates  Eligibility Information  This section is used to assess eligibility for employment in line with UK law. Are you a European Economic Area / EU national? Yes No If NO are you eligible to work in the UK without restriction? Yes No Please provide details eg what type of visa do you have/what is the expiry date? __________________________________________________________________________________________________________________ Declaration Your data is securely held by the College which has in place all the security measures required. Your data will be treated confidentially and with respect. The data will not be disclosed to any external organisations except where the external body is party to the recruitment process. If you are unsuccessful your application form will be destroyed 12 months after the vacancy interview date. Should you be successful in obtaining employment with LutubeƵ we will use your personal data for the purpose of an employee, HR Administration and any legitimate issues relating to your employment with the College. In doing so the College will observe at all times, the data protection principles embodied in the General Data Protection Regulations and the Data Protection Bill (previously Data Protection Act 1998). LutubeƵ will seek your explicit permission should it intend to process any sensitive personal data for any reason other than Equal Opportunities or exercising a legal right or obligation required by law. Sensitive data includes your racial or ethnic origin, sexual life, political beliefs, trade union membership, religious beliefs, physical or mental health and criminal offences. Please tick the boxes and sign this section to confirm your agreement to the statements listed in this section of the form. Please remember this information may be used as evidence should this be required in the future.Are you related to an employee of LutubeƵ? Yes NoIf yes, please state their name and your relationship  I confirm to the best of my knowledge that the information I have given is correct. I give my consent for LutubeƵ to obtain my attendance records from my previous employers. I give my consent for LutubeƵ to process my diversity monitoring information.  I understand that my appointment is subject to medical clearance, satisfactory references, DBS clearance and in appropriate cases; evidence of professional registration / qualifications will be required. I understand that, if my application is successful, the information will be used to compile a personal file/records and for payroll purposes and may be disclosed to the Inland Revenue. The information will be processed both manually and automatically.  I understand that providing false or misleading information during the recruitment and selection process may disqualify me from appointment or if appointed, may render me liable to dismissal. I declare the information I have given is to the best of my knowledge, true and complete. Name  SignatureDate   DIVERSITY MONITORING INFORMATION LutubeƵ collects equality monitoring information for a number of reasons broadly related to statutory duties and to monitor and promote its Diversity Policy. Diversity Monitoring is the process the College uses to collect, store and analyse data with regard to peoples diversity. It is useful to highlight possible inequalities, investigate their underlying causes and to remove any unfairness or disadvantage. Appointments are not based on the information that you give in this section but simply based on merit. LutubeƵ would like to assure you that the information that you provide will be treated in the strictest confidence and will only be used as permitted under the UK Data Protection (Previously Data Protection Act 1998). Please tick as appropriateDetailsPost Reference Number Post Applied ForName Age Gender e Male FemaleDate of Birth (dd/mm/yy) fDo you identify yourself as transgendered?( Yes ( No Ethnic OriginEthnic origin is not the same as nationality; place of birth or citizenship, but about your broad ethnic group. UK Citizens belong to a wide variety of ethnic groups.Please tick as far as possible, your ethnic origin.ASIAN OR ASIAN BRITISH Bangladeshi Indian Pakistani Other please specifyBLACK OR BLACK BRITISH African Caribbean Other please specifyCHINESE g Chinese Other please specifyMIXED h White & Asian White & Black African White & Black Caribbean  Other please specifyWHITE i English Irish Scottish Welsh Other please specifyOTHER ETHNIC GROUP Other ethnic group please specify Religion & Belief (Please tick one only)(Buddhist(Hindu(Christian (all denominations)(Jewish(Muslim(None(Other please specify : ((Sexual Orientation (Please tick one only)(Heterosexual(Gay(Prefer not to say (Lesbian(Bisexual DisabilityLutubeƵ has a statutory duty to monitor the employment rates of disabled people this requires us to use the definition of disability in the Equality Act. You are therefore asked to tell us if you have a mental or physical condition which has a substantive and long-term adverse effect on your ability to carry out normal day-to-day activities, which lasts or is likely to last for more than 12 months. Please answer the question below.Do you consider yourself to have a disability that satisfies the above condition? Yes NoIf yes, please indicate below the nature of this disability or condition and any support requirements you may need or wish to discuss with us. 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