Clerical

For Office Use Applicant No:

Confidential SO(48) The information you provide on this form will be used for recruitment & selection and employment contract purposes

Reference No:

PEC/ Closing Date:

Please complete this form in black ink or typescript and return it to: Leeds City Council Recruitment Service, 3rd Floor, Belgrave House, Belgrave Street, Leeds LS2 8DQ

Application for Employment as: Mr

Mrs

Miss

Ms

Other (please specify)

Last Name:

First Name: If the job includes driving, are you licensed to drive the appropriate vehicle? Yes/No (Please circle correct one)

Previous Name used:

If you hold an LGV licence, please state class:

National Insurance No:

If you are selected for interview, are there any dates when it would be impossible for you to attend?:

Address for Correspondence:

When would you be available for work? (period of notice) Postcode:

Do you wish to apply for:

Home Tel No: Work Tel No: Email:

Part Time Yes/No

Full Time Yes/No Job Share Yes/No

Please indicate the range of days and the maximum number of hours you are able to work

May we contact you at work?

Yes/No

Are you related to any Councillor or Employee of Leeds City Council? Yes/No (If yes, give details)

References Your 1st referee must be your current or last employer, (if you have one). Your 2nd referee should not be from the same organisation and may be a character reference from someone who knows you in your personal life. Referee 1. Title: Name: Occupation: Email:

Referee 2. Title: Name: Occupation: Email:

Address:

Address:

Postcode: Telephone No: Fax No:

Postcode: Telephone No: Fax No:

Capacity in which known:

Current Employer Previous Employer

Capacity in which known:

Please tick the appropriate box to indicate the capacity the referee is known to you

Current Employer Previous Employer Character Reference

For Office Use APPLICANT NO: XXXXX

(see EKnowledge m p l o y -m e nGuidance t E x pNotes) erience

Applicant No:

Current last occupation / position /scheme asked for in theDate Started:Specification gained either through work, Please or show that you have the knowledge Employee

education, home or voluntary activities. Salary:

Permanent/Temporary

(Please delete as appropriate)

Grade/Scale:

Reference No:

PEC/

Date left (if applicable):

Workplace if different

Employer: Address:

Telephone Number:

Telephone Number: Briefly describe your duties:

Previous jobs or work experience (Most recent first. Please account for any period between leaving full time education and commencing employment, and also any periods of unemployment which may have occurred between previous appointments). Please attach sheet with extra information if required. Name of Employer

Date from Date to Month Year ExpeMonth rienceYear - (see

Position held and main duties

Guidance Notes)

Reason for Reason for Leaving Leaving

Please show that you have the experience asked for in the Employee Specification gained either through work, home or voluntary activities.

Education, Training and Qualifications (Most recent first. Please show education, training and qualifications, including Apprenticeships and Membership of Professional or Technical Bodies. Please attach sheet with extra information if required. Month & Year From To

Education Establishment

Examinations taken or being studied Training courses attended

Skills - (see Guidance Notes)

Month & Year Awarded

For Office Use Knowledge, Experience, Skills or Competencies - (see Guidance Notes) Please show that you have the knowledge, experience, skills or competencies asked for in the Employee Specification gained either through work, education, home or voluntary activities.

Applicant No:

Reference No:

PEC/

For Office Use

A d d i t i o n a l I n f o r m a t i o n (See Guidance Notes)

Applicant No:

Do not exceed two sides of A4 paper (this does not apply to Disabled Applicants). If you include additional sides of paper, please tick the appropriate box: one

two

Reference No:

PEC/

Please show how you meet the additional factors on the Employee Specification and use this section if there is any other information you wish to add in support of your application. Please attach sheet with extra information if required. CV’s are Not allowed.

Because of the nature of some posts it is essential you complete the declaration section accurately. Applicants recommended for posts working with, or having access to, either Children or Vulnerable Adults will have a check carried out through the Criminal Record Bureau. For some posts you may be required, if successful, to undergo a medical examination. In discharging its functions the council is covered by the Rehabilitation of Offenders Act 1974 (exceptions) order 1975 and you are obliged to disclose all convictions and cautions no matter how long ago they occurred and regardless of whether the offences were committed as an adult or a juvenile. This will not necessarily bar you from applying, it will depend on the nature of the position and the circumstances and background of your offences Do you have any convictions or cautions? Write Yes or No

Are you currently the subject of any criminal proceedings or police investigations? Write Yes or No

If either answer is yes then please give details below.

Date

Nature of Summons/Charge/Caution/Allegation

Court

Sentence or Order

I understand that public funds must be protected and so the information I have provided on this form may be used to prevent and detect fraud. The information may also be shared, for the same purposes, with other organisations, which handle public funds. I can confirm that, to the best of my knowledge, the information provided on this form is correct and gives a fair representation of my qualifications and employment history and that if it is subsequently discovered that I have wilfully or negligently given false information or withheld information. I will be liable to immediate dismissal and may be prosecuted. I understand that canvassing directly or indirectly will be a disqualification

Signature:

Date:

For Office Use

Equal Opportunities

Applicant No:

We promote diversity and want a workforce which reflects the people of Leeds. We will use your answers to monitor and check the fairness of our recruitment. Any information you provide will be kept confidential. You do not have to answer these questions and if you do not then it will not make any difference to your application.

Reference No:

(Please highlight your selection or delete what is not applicable)

Male

Female

Date of Birth

Are you Disabled?

Yes/No

Do you consider yourself to meet the Disability Discrimination Act definition of a Disabled Person? (See Guidance Notes) Yes/No

Ethnic Origin

(please highlight your selection) Asian or Asian British Bangladeshi Indian Kashmiri

AB AI AK

Pakistani Other (Specify)

AP

Black or Black British African Caribbean Other (Specify)

BA BC

Mixed

Chinese CC Gypsy/Traveller GT Other (Specify)

White

White and Asian White and Black African White and Black Caribbean Other (Specify)

Please identify your marital status:

MA MF MC

British Irish Other (Specify)

Married Single

Please identify your religion:

Other ethnic groups

Civil Partnership

WB WI

Co-habiting

Other ………………………..

Buddhist No Religion

Please identify your sexual orientation: Heterosexual (definitions below)

Christian

Hindu

Jewish

Rastafarian

Sikh

Lesbian

Gay man

Muslim

Other ………………………..

Bisexual

Heterosexual – Someone who is attracted, emotionally and or physically, to persons of the opposite sex. Lesbian – A woman who is attracted, emotionally and or physically, to other women. Gay man – A man who is attracted, emotionally and or physically, to other men. Bisexual – Someone who is attracted, emotionally and or physically, to both sexes.

Qualification Please identify your highest educational qualification (whether relevant to the post applied for or not) Month & Year

Education Establishment

Qualification

For Office Use

For Disabled Candidates only

Applicant No:

To help recruiter’s decide whether a reasonable adjustment will be required, please answer the following questions.

Reference No:

Does your impairment prevent you from carrying out any of the duties of the post? Yes/No If yes, you are still encouraged to apply, as we may be able to make some changes to accommodate a suitable disabled candidate. It would be helpful if you could let us know what the potential changes might be. If called for an interview, does your impairment require us to make any particular arrangements? If yes, please describe. It would be useful if you could give us any information you have about how these might be overcome. If you do not let us know at this stage what your needs are, there is no guarantee that we can meet them if you let us know at a later date.