Confidential – please type this form or complete it using black ink

Section 1 Job details

Application for post of:      
Directorate:       Section or team:      
Ref number:       Grade:       Closing date:      
Section 2 Personal details
Title (Mr, Miss, Mrs, Ms, other):       Surname:      
Forename(s):       Previous surname:      
Address:      

Postcode:      
Telephone numbers
Daytime:       Evening:      
Mobile:       Email address:      
Section 3 Present or last employer
Name of organisation:      
Contact name:       Telephone number:      
Address:       Email address:      

Dates from:       to:       Grade:      

Position held:       Salary:      
Main duties and responsibilities:      

Period of notice:      

If this is your last employer, please state why you left:      

If this is your present employer, please state why you are applying for the post:
     

Section 4 Previous employment

Please provide details of all your previous employment, accounting for any
gaps. You should use a separate box for each position held, starting with the most
recent and work back. Continue on a separate sheet if needed.
Name of organisation:      
Contact name:       Telephone number:      
Address:       Email address:      

Dates from:       to:       Grade:      

Position held:       Salary:      
Main duties and responsibilities:      

Period of notice:      

Reason for leaving:      
Name of organisation:      
Contact name:       Telephone number:      
Address:       Email address:      

Dates from:       to:       Grade:      

Position held:       Salary:      
Main duties and responsibilities:      

Period of notice:      

Reason for leaving:      
Name of organisation:      
Contact name:       Telephone number:      
Address:       Email address:      

Dates from:       to:       Grade:      

Position held:       Salary:      
Main duties and responsibilities:      

Period of notice:      

Reason for leaving:      
Section 5 Membership of professional body – if successful, we will ask you to
provide evidence of membership.
Specific
Name of Level of responsibilities, for
Date of entry
professional body membership example,
chairperson
                       
                       
                       
Section 6 Qualifications and training – if successful, we will ask you to provide
evidence of qualifications achieved.
Please give details of all the qualifications you have achieved starting with the
most recent. Continue on a separate sheet if needed.
Date achieved or
Level, for example
Qualification expected to
GCSE, NVQ, BSc
achieve
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 

Training – please give details of any training and development activities you have
completed that you feel are relevant to your application. Continue on a separate
sheet if needed.
Training activity Duration Date
                 
                 
                 
                 
                 
                 
                 
                 
Section 7 Other relevant skills and knowledge – please use this section to
explain why you are applying for the job. Concentrate on how your experience,
training and personal qualities match the requirements of the job description and
person specification. Continue on a separate sheet if needed.

     
Section 8 Criminal convictions
Even though you are required to disclose any ‘unspent’ criminal convictions in line
with the Rehabilitation of Offenders Act 1974, we will not necessarily exclude you
from employment if you have a criminal record. We will treat the information you
provide as strictly confidential and we will only take this into account when the
conviction is relevant.
Do you have any unspent convictions? Yes No
If you have said ‘Yes’ above, please detail offence(s) including date(s) and
sentence(s). Continue on a separate sheet if needed.

     

You are required to give details of all criminal convictions even if they are ‘spent’
for certain jobs. If this applies to the post you are applying for, we will clearly
indicate this in the supporting information and you must complete the questions
below.
Do you have any ‘spent’ convictions? Yes No
If you have said ‘Yes’ above, please detail offence(s) including date(s) and
sentence(s). Continue on a separate sheet if needed.

     

Section 9 Immigration, Asylum and Nationality Act 2006

Are you subject to immigration control? Yes/No      

Do you need a certificate of sponsorship to work in the UK? Yes/No      

Section 10 Referees
Please supply the names and addresses of two people who are not related to you
who we can contact for a reference. One must be your current or most recent
employer. If you do not have any previous employment experience, a reference
related to relevant voluntary and community work or if appropriate your
headteacher/lecturer/tutor will be acceptable. You should not ask elected
members of the council (councillors) or a relative to be a referee. Please tick
the box if you do not wish us to contact your referees before an offer is made.
First referee’s details Second referee’s details
Name       Name      
Job title       Job title      
Organisation       Organisation      

Address       Address      

Telephone number       Telephone number      

Email address       Email address      
Reference type Reference type
Employer Employer
Education Education
Character Character
Section 11 Administration
Where did you see the post advertised?      
If you are related to or in a relationship with an elected member of the Council
(councillors) or an employee of the council\school, please give details here.      

Have you ever received early retirement and\or a redundancy payment from
Knowsley Borough Council? If yes, please give details here.      

If the job you are applying for requires you to travel, please answer the following
two questions.

1. Please state what type of driving licence you hold and provide details of any
endorsements or penalty points.
Eligible to drive a minibus
Provisional Full Other None
(category D1)
Details of endorsements or penalty points.

     
2. Do you have regular If you do not have regular access to a car, can you
access to a car? provide alternative mobility?
Yes No Yes No
Data Protection Act 1998 – we will hold information on this form on manual and
electronic records. We will keep the information confidential and only use it for
payroll and personnel administration purposes. If your application is unsuccessful,
we will hold the data for six months and then destroy it.
Entitlement to work in the UK - to comply with the Immigration, Asylum and
Nationality Act 2006, all potential employees will be required to supply evidence of
eligibility to work in the United Kingdom (UK).
Declaration - I confirm that the information I have provided on this form is
accurate and true. I understand that the canvassing of any councillor or employee
of the council or giving false information will make my application unacceptable
and, if appointed, may lead to my dismissal. I understand that if I am appointed,
personal information about me will be computerised for payroll\employee
administration purposes including analysis for management purposes and
statutory returns. In signing this form I give my authority for use of my personal
data for these purposes.
Name       Date      

If you return this form by email without a signature, we will assume that you
have accepted the declaration.
Reference Consent Form

Should my application be successful, I herby give consent for my current employer to

release information regarding my employment inclusive of:

 Job Title
 Salary details
 Employment start and end date, including any previous service details
recorded under the modification order
 Contract status
 Contracted hours
 Reason for leaving
 Sickness information

To Knowsley Council, Human Resources Department, Westmorland Road, Huyton,

L36 9GL.

Full Name:

Date of Birth:

Payroll Number / NI
Number:

Signature:

Date:
Section 12 Equal opportunities monitoring – we will keep this information
separate from your application form and those responsible for short listing or
interviewing applicants will not see it.
We believe that the decision to appoint should be based upon the requirements of
the job and whether an individual’s skills, experience, qualifications and abilities
make them the most suitable candidate. We do not believe that an applicant’s
ethnic origin, colour, religion, sex, disability, age, marital status, political or sexual
orientation should have any effect upon their suitability. Please fill in the following
section to help us examine our efforts in promoting fairness of employment
opportunity for everyone. We will keep the information on this section confidential.
If your application is unsuccessful, we will hold the data for six months and then
destroy it.
Surname       Forename(s)      
Ref number       Post applied for      
Grade       Hours      
Salary       Date of birth      
Gender – please tick Male Female
Disability – we ask these questions in accordance with the Equality Act 2010.
The information you provide will help us to help you through the application and
interview process.
Do you consider yourself to have a
Yes No Prefer not to say
disability? Please tick
Would the provision of any aids or adaptations assist you in carrying out the duties
of this post? Please give details.

     
Is there anything we need to know about your disability in order that you can have
a fair interview? For example do you need a sign language interpreter, an
accessible interview room? Please provide details.

     
Ethnic monitoring - the following groups are recommended by the Equalities and
Human Rights Commission and take into account those used in the National
Census.
White
A1 English, Welsh, Scottish, Northern Irish, British
A2 Irish
A3 Gypsy or Irish traveller
A4 Any other white background. Please provide details.      
Mixed or mixed British
B1 White and black Caribbean
B2 White and black African
B3 White and Asian
B4 Any other mixed or multiple ethnic background.
     
Please provide details.
Asian or Asian British
C1 Indian
C2 Pakistani
C3 Bangladeshi
C4 Chinese
C5 Any other Asian background. Please give details.      
Black, African, Caribbean or black British
D1 African
D2 Caribbean
D3 Any other black African or black Caribbean
     
background. Please give details.
Other ethnic group
E1 Arab
E2 Any other ethnic group. Please give details.      
Prefer not to say
Religious belief – how would you describe your religion or belief? Please tick or
provide details where appropriate.
Buddhist Muslim
Christian Sikh
Hindu No religion
Jewish Prefer not to say
Other belief. Please give details.      
Country of birth
     

Please email your completed application and equal opportunities monitoring form
to recruitment@knowsley.gov.uk If you are unable to submit your application
form by email please contact the HR Business Unit on Tel 0151 443 2960