HR17520

(26.08.16)

PRIVATE AND CONFIDENTIAL

APPLICATION FOR EMPLOYMENT

Bedfordshire Fire and Rescue Service is an equal opportunities employer. We recruit on merit and suitability. Applications are welcome from all people with the relevant skills and potential to do the job. This form should be completed in black ink or typescript. Please answer all the questions on the form. You should read the ‘Guidance Notes for all Applicants’ before starting.

Application for appointment as:

Title: / Telephone number: / Home:
Work:
Mobile:
Full name:
Address:
Post code: / National Insurance number:
E-mail address

PRESENT/LAST APPOINTMENT

Employer (Name, postal address and e-mail) / Post Held / Salary / Date of Appointment / Length of Notice
Brief Summary of Duties and Responsibilities:

EDUCATION AND TRAINING

Subject / Qualification / Grade / Date / School/College


CAREER/WORK EXPERIENCE

Please include any voluntary/unpaid work and periods of unemployment. Put the most recent first, beginning with your current or last employer, and give details of previous employers since leaving school/college.

Employer (Name, postal address and e-mail) / Position held / Salary / From
Month/
Year / To
Month/
Year / Reason for Leaving


REFERENCE AS TO CHARACTER

In the space below please provide the details of two persons to whom application may be made regarding your character. The persons named must not be related to you, and should not include your current employer or most recent employer.

Name / Postal address / E-mail address / Profession / Length of knowledge of applicant

We will seek references from your character referees, current employer, past employers and educational establishments attended if you are successful at interview. Full details are available from the Human Resources Section on request.

Please tick if you would prefer us not to contact your current employer without further reference to you.

DECLARATIONS

CRIMINAL RECORDS – OFFENCES NOT SPENT

You are required to declare here any convictions for offences which are not spent under the Rehabilitation of Offenders Act 1974, including offences dealt with by a court of law or by HM Services disciplinary procedure. You are advised to state any charges which are pending.

The amendments to the Exceptions Order 1975 (2013) provide that certainspent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken intoaccount. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service (DBS) website.

If offered employment you will be required to complete a DBS check if this is applicable to the post, which will reveal any disclosable criminal offences.

If you have no offences or charges pending to declare write 'None'.

Offence / Place / Date / Judgement / Sentence


RELATIONSHIPS

Are you, to your knowledge, related to any elected Yes

representatives or employee of the Fire and Rescue Authority? No

If so, give details:

CANVASSING

Canvassing of members or officers of the Fire and Rescue Authority, directly or indirectly, in connection with this application will disqualify the candidate.

DRIVING LICENCE

Do you hold a full UK driving licence? Yes No Automatic only

Please give full details of any motoring convictions or impending prosecutions and details of fines or sentences imposed including fixed penalty notices (if drink/drive conviction - state milligram reading).

If offered employment your driving licence will be checked against the Driver and Vehicle Licensing Agency central database, which will reveal unspent offences.

If you have no offences or charges pending to declare write 'None'.

Offence / Place / Date / Fine/Sentence

DATA PROTECTION ACT

Information on this form may be held electronically. Strict confidentiality will be observed and disclosures will only be made for payroll and people administration purposes and to meet the requirements of the Data Protection Act.

Any false information may, in the event of employment, result in disciplinary action or dismissal.

DECLARATION

I declare that the information given in this application is true and accurate to the best of my knowledge and belief. I have not canvassed directly or indirectly any members or officers of the Fire and Rescue Authority and will not do so. I have read the Data Protection Act section and agree to the use and retention of my personal data.

Signed Date


Please return completed application forms to:

E-mail:

Human Resources Section

Bedfordshire Fire and Rescue Service HQ

Southfields Road

Kempston

BEDFORD

MK42 7NR

Tel: 01234 845000

Name: / Position Applied for:

Please use this page (and any additional pages) to state how you meet the essential criteria that are listed on the person specification.

This page will be used in conjunction with the Application for Employment to assess your application. CVs are not accepted as evidence for this section.


ED05a

(23.03.15)

Application Number:

Equality Monitoring: Equality Act Recruitment Data

This form is to be used for monitoring purposes.

Personal Data maybe processed in line with the Data Protection Act 1998.

Gender / Sexual orientation / Religion/Faith
r  Male
r  Female
Is this the gender you were given at birth?
r  Yes
r  No
r  Prefer not to say / r  Bisexual
r  Gay man
r  Lesbian
r  Heterosexual
r  Other
r  Prefer not to say / r  No religion/faith
r  Christian
r  Buddhist
r  Hindu
r  Sikh
r  Muslim
r  Jewish
r  Other *
r  Prefer not to say
*Please specify:
Ethnicity / Disability
White
r  English / Welsh / Scottish /Northern Irish /British
r  Irish
r  Gypsy or Irish Traveller
r  Any other white background *
Mixed
r  White and Black Caribbean
r  White and Black African
r  White and Asian
r  Any other mixed background *
Black/African/Caribbean/Black British
r  African
r  Caribbean
r  Any other black background *
Asian/Asian British
r  Indian
r  Pakistani
r  Bangladeshi
r  Chinese
r  Any other Asian background *
Other ethnic group
r  Arab
r  Any other ethnic group *
r  Prefer not to say
* Please specify: / Are your day to day activities limited because of a health problem or disability which has lasted or is expected to last at least 12 months
r  No
r  Yes – limited a little
r  Yes – limited a lot
r  Prefer not to say
If yes, please briefly state the nature of
your disability:
Candidate Details
Name:
Date of Birth:
Date:
So that we can check the effectiveness of our advertising, please state how you learned of this vacancy (Please tick)
r  Newspaper (give name) -
r  Other Publication (ie magazine, periodical etc) -
r  Job Centre -
r  Other (Please specify details)