Jobs and Careers

Leicester
City Council

School / College

RUSHEY MEAD SECONDARY SCHOOL

Post

Surname

Initials

Postal Address (for correspondence)

Post Code

Home Tel No.

Business Tel No.

NI Number

Date Recognised as qualified teacher

DFEE Reference No.

If teaching : Name and Address of education Authority
(give Area / Division if any)

Name and Address of School / College

Group Size

No. on Roll (approx.)

Age Range

Date appointed

Please state Status and Salary giving details of any specific responsibility and level of any Incentive Allowance payable.

FE Head of Department Grade Please select

£

If other than teaching: Post

Name and Address of Employer

Date Appointed

Salary £

School / College (please give address)

from

to

Full time

Part time

Examinations Passed

Date

Subjects and Grades

G.C.E. 'O' level or equivalent

G.C.S.E. 'A' level or equivalent

G.C.S.E.

Other
(please specify examinations past post qualification)

From

To

School / College /University

Qualifications obtained, with class and dates

Institution

Class of membership

Year of election

Name of Education
Authority and
Division or Area

Name and type of
school / College and
whether single sex

Approx. No.
on Roll and
Group No.

Post title,
Grade or Scale,
Full or Part time

Dates
(months and year)

From

To

Name and Employer and Address

Post and Nature of Employment

Dates
(month and year)

From

To

Subject

Organising Body

Duration

7. Selection Arrangement:
In finalising our selection arrangements, are there any issues that you would like us to consider? e.g. dates and times you are unavailable, Large print or braille test material, Sign language interpreter, fully accessible venue, etc.

We will aim to cater for individual circumstances, but cannot guarantee that we will always be able to do so.

8. Equality Monitoring:
We ask for this information to monitor achievement of our Employment Equality policies. Appointments are not based on information given here. For each item below, respond as indicated.

Sex:
I am a
Male

Disability:
I am
Not Disabled

Date of Birth
My Date of Birth is

Media Source:
Where did you see / hear about this post

Ethnic Origin:

I am white of

I am Black of

I am Asian of

I belong to some other group(s)

9. Referees
one of whom should be your present (or last) employer. References will only be taken up for applicants selected for interview, and you should ensure your referees are in a position to respond promptly.

Name:

Position held by Referee:

Organisation:

Address:

Postcode:

Telephone:

Name:

Position held by Referee:

Organisation:

Address:

Postcode:

Telephone:

9. Letter of Application
You are requested to submit a letter in support of you application, addressing issues you regard as relevant to the post as prescribed in the Job Details supplied. If necessary, use a Curriculum Vitae to present factual information which may not have been included in the application form.

10. Declaration
I declare that all information submitted in this application form is true, that I have not canvassed any Member, Employee or Committee of the City Council of Governor of the school/college either directly or indirectly, in connection with this application and will not do so. I understand that such canvassing will disqualify me as a candidate. I further understand that failure to disclose my relationship with a Member or Employee of the City Council or Governor of the school/college may also disqualify me and that if such failure is discovered after appointment I will be liable to dismissal without notice, and confirm that I have read the notes relating to convictions and spend convictions of a criminal nature. I attach a letter of application in support of this form along with format prescribed in the Job Details supplied to me.

Date …………………………… Signed …………………………………………………

11. Notes
A. When completed, this form should be addressed to the Principal/Head Teacher c/op the school/college, to be received by the closing date expressed in the job details.
B. Receipt of your application will be acknowledged If you received no further communication by the proposed interview date, your application will have been unsuccessful.
c. Canvassing, directly or indirectly, will disqualify.
d. Teachers aged 50 and over are advised that, if they have previously accepted early retirement from a teaching post and, if appointed to a new post, they should advise the Paymaster General, the Department of Education and Employment and their previous employer of their change of circumstances.
e. Candidates recommended for appointment will be required to complete a medical questionnaire, which will be supplied after the interview, for submission to the Occupational Health Unit and may then be required to undergo a medical examination.
f. Because of the nature of the work for which you are applying this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders 1974 (Exceptions) Order 1975. Applicants are therefore, not entitled to withhold information about convictions which for other purposes are 'spent' under the provisions of the Act, and, in the event of employment being taken up, any failure to disclose such convictions could result in dismissal or disciplinary action by the Authority. The fact that a conviction has been recorded against you will not necessarily debar you from the consideration for this appointment.

The object of this Notice is not, in any way, to reflect upon applicants' integrity, but is necessary to protect the public and the Council. - (See separate sheet attached).

12. EQUAL OPPORTUNITIES IN EMPLOYMENT - IMPORTANT

a. Policy
Leicester City Council is an Equal Opportunities Employer. It is the policy of the City Council that no job applicant or employee shall receive less favourable treatment because of his or her sex, marital status, ethnic, cultural or national origins, disability, age or any other condition which cannot be shown to be justifiable.

Reference should be made where necessary to the Sex Discrimination Act, 1975, The Race Relations Act, 1976, the Disabled Persons Acts, 1944 and 1958 and the Disability Discrimination Act 1996. A full copy of the City Council's Policy Statement is enclosed

b. Monitoring
For the policy of equal opportunities to be effective it must be certain that unfair or illegal discrimination is not taking place. The City Council, supported by its Trades Unions, considers that in order to achieve this and to ensure the continued development of its policies, it must keep up-to-date information about job applicants. All applicants for employment are, therefore asked to complete Equality Monitoring Section of this form.

The information which you give WILL NOT be used by those involved in the selection procedure; it is for STATISTICAL PURPOSES ONLY.

Leicester City Education Committee

Notice to applicants
Re: Convictions and 'Spent' Convictions of a Criminal Nature

You will appreciate that the Education Authority must be particularly careful to inquire into the character and background of applicants for appointment to posts involving contact with children under the age of 18. It is therefore essential that, in making your application, you disclose whether you have ever been convicted of a criminal offence and, if so, for what offence(s). Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4 (2) of Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders (Exemptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendments) Order 1986. The fact that conviction(s) have been reported against you will not necessarily debar you for consideration for this appointment.

You must, therefore, answer the question at the foot of this notice "have you ever been convicted of a criminal offence?" (please answer "yes" or "no"). If the answer is "yes", you must give details, which may, if you wish, be enclosed in a separate, sealed envelope marked "confidential" and attached to the application. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies. The object of this Notice is not, in any way, to reflect upon applicants' integrity but it is necessary to protect the public and the Council.

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 Leicester Constabulary for a search by the Criminal Records Office, regardless of the answer given to the question concerning previous convictions.

Acceptance of an offer of appointment will be deemed to be acceptance that such an investigation may take place. Applicants are informed that providing false information is a disciplinary mater and may result in summary dismissal.

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

Question

Have you ever been convicted of a criminal offence? Yes / No

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