Shelley Application Form
Shelley Application Form
Job title:
Vacancy No:
School:
Personal details
Postcode:
Email address:
Work: Home:
Telephone:
Mobile:
DFES No (if applicable):
If the job requires you to have a driving licence please tick which type of licence you hold:
Full HGV PSV None
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Reference – remember to ask your referee/s for permission before you give their name.
Name:
Address:
Post Code:
Tel:
Email:
Occupation:
Relationship:
May we contact this person if you are invited for interview Yes No
Name:
Address:
Post Code:
Tel:
Email:
Occupation:
Relationship:
May we contact this person if you are invited for interview Yes No
A reference will only be requested when you are invited for an interview. One referee must be your
present or most recent employer. Your referee will be asked for information regarding your sickness
absence record during the past 24 months as well as details of any disciplinary action during the past
12 months. If you are applying for a Headship your local education authority will also be asked for a
reference.
The information provided on this application is true and I have not canvassed (either directly or
indirectly) any councillor or officer of Kirklees Council and will not do so. I am aware that to withhold
facts or falsify information could result in disciplinary action leading to dismissal.
Signed:
Date:
Data Protection Act 1998 applies. We will treat all information relating to your application in
confidence. If you are unsuccessful, your form will be destroyed 6 months after the closing date
although the Council reserves the right to add your details to our database of suitable candidates for
other similar posts. We also sometimes contact job seekers for recruitment research.
If you do not wish to be contacted or added to our database, please tick this box
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Work History
Present Employment, paid or unpaid (or last job for applicants currently unemployed)
Job title:
Date employment
started:
Date employment
ended:
Reason for leaving
(if applicable):
Notice required
(if applicable):
Name of employer:
Name of employers
authority/agency:
Address:
Post Code:
Current Salary:
Grade:
Briefly describe
your duties:
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Previous Employment
This section deals with your previous employment. Start with the most recent and please include any relevant part-time, casual or voluntary
work. We need details of previous employment (paid or unpaid), and also periods of non-employment e.g. child care etc. If you use additional
sheets please remember to put your name and the post applied for on each extra page and number it.
Job Title Main Duties Name and Address of Employer From To Wage/Salary Reason for Leaving
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Education and Qualifications
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This section deals with your school education/further. Please include the dates when you started and finished each level of education. (Sight of
original certificates would BE required if you are successful)
If you need more space, please attach additional sheets and tick this box
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Relevant Information
Please read this section carefully as this is the most important part of your application
Using this page and if needed additional paper demonstrate your ability to meet the requirements of
the job by giving clear, concise examples of each criterion in the Employee Specification in the
following order or by completing the questionnaire if attached:
Relevant Experience, Education and Training Attainments, General and Special Knowledge, Skills and Abilities, Additional Factors
If you need more space, please attach separate sheets and tick here
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Criminal Convictions
REHABILITATION OF OFFENDERS ACT (EXEMPTIONS) ORDER 1975
NOTE:
The Rehabilitation of Offenders Act 1974 provides that certain criminal convictions become ‘spent’
after the passage of time, that is the law will treat them for most purposes as if they had never
happened and it is not necessary to disclose them on Application Forms. However, the
Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 contains certain classes of
employment where a person can be asked to disclose spent convictions. The post for which you are
now applying falls within that order and you are therefore required to detail below previous
convictions, cautions or bind-overs, whether or not they are spent.
For posts that are subject to a disclosure, please note that a criminal record will not necessarily bar
you from employment. This will depend on the nature of the position and the circumstances and
background of the offence.
Failure to disclose information concerning previous convictions, cautions or bind-overs may lead to
dismissal or disciplinary action by the authority. Any information given will be treated in the strictest
confidence and will be considered only in relation to an application for posts which the order applies.
I declare that the particulars given are correct and I have not withheld any facts which might
unfavourably affect my application. I am aware that to withhold or falsify information could result in
dismissal or disciplinary action.
Please do not just sign this statement without declaring in the space provided above either ‘No
convictions, cautions or bind-overs’ or give details of all offences of which you have ever been
convicted.
Last name:
First name:
Signed: Date:
N.B. If you fail to complete this section of the application form you may not be shortlisted or invited to
attend for an interview.
We will treat all information provided on this form in the strictest confidence.
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Statement of Health
There are many posts which involve a high level of physical and strenuous effort or require a high
level of fitness/mobility.
Applicants who feel they may be restricted by their health, either through their fitness or mobility,
may need to enquire further as to the demands of the post.
After reading the Job Description, if you feel you may have some restrictions which may cause you
difficulties in carrying out the duties of the post, please indicate by ticking the box at Statement A
below, and include details. If you feel that you will have no restrictions in carrying out the duties of
the post, please tick the box at Statement B.
A I list below the fitness/mobility restrictions related to my health which I believe are relevant in
respect of my application for this post.
B After reading the Job Description, I know of no reason regarding my state of health which
could be in any way detrimental to carrying out the duties of this post.
Last name:
First name:
Signed: Date:
Sickness Absence
Please list below all periods of sickness absence over the last 24 months, detailing both the nature
and duration of each period of absence.
Date Nature of Sickness Duration
I agree to a medical
examination if
necessary
Signed: Date:
Additional Information
1. If you are in receipt of a pension payable under the Teachers’ Pensions Regulations following early
retirement, please indicate the grounds on which you were retired:
*in the interests of efficiency / redundancy / ill health (delete as appropriate)
Date of retirement
2. If you have received a redundancy payment in respect of a previous employment with a local
authority, please give details.
Name of Authority
Date of redundancy
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Signed:
Date:
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Job title:
Vacancy No:
School:
Name:
We are committed to employing a workforce that reflects the community we serve. Please help us to
monitor our progress by completing the details below. Your information will be treated confidentially.
Chinese or
Other Ethnic Chinese Any other ethnic group (please specify)
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Disability
We have to ask you if you are disabled as defined under the Disability Discrimination Act(1995). As a
disabled person, under this definition, you have ‘a physical or mental impairment which has a
substantial and long term adverse effect on your ability to carry out normal day-to-day activities’.
Do you consider
yourself to be disabled
under this definition?: Yes No
If you have answered
No to the question
above, do you
personally consider
yourself to be a
disabled person? Yes No
Sexual Orientation
If you wish to, you may disclose information about your sexual orientation below:
Heterosexual Gay Lesbian Bisexual
I do not wish to disclose information about my sexual orientation
Religion
If you wish to, you may disclose information about your religion below:
Christian Buddhist Hindu Jewish Muslim Sikh
Any other (Please specify)
I do not wish to disclose information about my religion No religion
The information you provide will be used to produce statistics for equal opportunity and recruitment
monitoring only. Please see Guidance for Applicants regarding completing Equal Opportunities
Monitoring Form below.
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Kirklees Council
Kirklees is situated in West Yorkshire and covers an area stretching from the high moorlands of the
Pennines eastwards to the edge of Leeds and Wakefield. It is a district of great contrast – busy
commercial areas and open countryside. The two largest towns in the district are Huddersfield in
the South West and Dewsbury in the North East.
The Council serves a diverse population consisting of approximately 383,000 people whom around
10.9% are from minority ethnic communities and 14% have some form of disability. Kirklees has
responsibility for all aspects of Local Government and employs 12,000 full time equivalent staff.
Applying for a job with Kirklees
Completing the application form is the first step in the recruitment process which may lead to an
interview, and a possible offer of a job.
It is therefore important that you complete all sections of the application form as clearly and fully as
possible. Please type or write your form in black ink. We may have to photocopy the form and some
other colours have poor reproductive qualities.
Job Description and Employee Specification
You have received a job description which list the duties that you will be expected to carry out and an
employee specification which lists the qualities that the Recruitment and Selection Panel will be
seeking from you. Please read these carefully and ensure that your application demonstrates your
ability to fulfil these criteria.
The Application Form
If you have applied for more than one job, complete a different form for each post, because the
employee specification may be different.
If you feel you need more space, attach extra sheets as necessary.
If you use extra pages put your name on these sheets together with the reference number shown on
the advertisement.
Please do not send a Curriculum Vitae (C.V.), instead of an application form as it cannot be accepted
for consideration by the Panel.
Job Share
Kirklees Council operates a job share policy under which two people can share one full time job.
If you wish to job share, please indicate when applying.
Please remember that each individual job sharer’s application will be considered on its own merits.
Work History
Please provide details of present and past employers. Include details of any part time or voluntary
work/experience relevant to the post.
Relevant Experience
Check the employee specification and give examples of your experience for each criterion. This
could have been from work, home or voluntary activities.
Education and Training
If a qualification is asked for in the employee specification, make sure that you give all the
information required and levels of any examinations such as GCSE, CSE, RSA, NVQ, “A/O” Levels,
(also any qualifications you may have gained abroad). You are advised to ensure that you either have
original certificates available, or can submit original notification from the relevant examining bodies.
If applying for a teaching post you must hold a qualification recognised for qualified teacher status
under the terms of the Education (Teachers) Regulations 1993 or any subsequent regulations.
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and Finally!!
Remember it may help you if you photocopy and keep a copy of the application form.
Please get your application form in on time and GOOD LUCK!
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