THE POCKLINGTON SCHOOL FOUNDATION
Application Form for a Support Staff Post
Please note the Foundation does not accept CVs as part of the application process, therefore you should complete this form in full.
When completed, this form, together with a covering letter, should be posted or faxed to:
The Personnel Services Manager
Pocklington School
West Green
Pocklington
York YO42 2NJ
The Pocklington School Foundation, Registered Charity 529834, comprises Pocklington Pre-School and Pocklington School
Pocklington School Trustee Limited, Registered in England and Wales, Company Number 6560143, administers the Charity
Registered Office: West Green, Pocklington, York YO42 2NJ
telephone 01759 321212 facsimile 01759 306366 e-mail www.pocklingtonschool.com
1. Contact details
Full Name: (please underline the name(s) by which you like to be known) / Title:Former surnames: (e.g. maiden name or where there has been any previous change of name)
Current address:
E-mail address: / Tel No:
Fax No: / Mobile No:
2. Other information about you
NI No: / Current total gross annual salary:How much notice do you have to give your current employer?
Do you have a family or close relationship to existing employees, governors or parents? Yes/No
If yes, please give details:
3. Details of all education and qualifications.
(Including GCSE/O-level, A Level and further/higher education)
School, College, University or other body / Dates of attendance / Qualification, subject, / Class/grade awarded / Date Awarded4. Career History
Please supply, in chronological order, details of all employment, self-employment and any periods of unemployment since leaving school, giving reasons for leaving each employment.
Please provide, where appropriate, explanations for any periods not in employment, self-employment, training or further/higher education. You may use the continuation sheet at the back if necessary.
To and From dates (mm/yy) / Details of employment, self-employment or unemployment (e.g. employer, job title, main duties) / Reason for leaving5. Overseas Working/Living
Please give details of any periods of time you have spent overseas in the last 5 years which amounts to more than 3 months. (Use the continuation sheet if necessary).
To and From dates (mm/yy) / Details6. Other responsibilities
To and From dates (mm/yy) / Details of any other capacities in the past two years in which you have worked with children including contact details / Reason for leaving7. Professional development and training
Please give details of any relevant training you have undertaken in the past three years.
Date(mm/yy) / Course title or description / Course provider
8. Other interests and activities
Please give information about any interests, hobbies or activities in which you are involved, indicating any activities that you would like to offer as your extracurricular contribution (including games) and standard, where appropriate.
9. Your interest in this post
Please state why you are applying for this post and say what particular attributes, qualities or special areas of interest or expertise you would bring to it. (Use the continuation sheet if necessary).
10. The welfare, protection and safety of pupils
Pocklington School Foundation is committed to safeguarding and promoting the welfare of children. The successful applicant will be required to undertake an enhanced disclosure from the DBS. As part of our selection process, short-listed candidates should expect us to seek to clarify any anomalies or discrepancies in the information provided by them or arising from their references. The interview process will explore candidates’ suitability for working with children and their previous experience in such roles. Additionally, we will verify identity and academic and vocational qualifications and ensure that a candidate has the health and physical capacity for the job. Providing false information is an offence and could result in referral to the police.
Pocklington School Foundation works within the framework of the East Riding Safeguarding Children Board.
CHILDREN ACT, 1989The Children Act, 1989 places a statutory obligation on schools to safeguard and promote the welfare of children attending them. Accordingly, the Governors of Pocklington School Foundation require all new appointees to provide the following information:
Has the Secretary of State for Education ever issued you with a personal warning or caused your name to be included on List 99 which names those who may not be employed in schools? YES/NO
Have you ever been the subject of an investigation or enquiry by the Police or Local Authority in relation to a child or children? YES/NO
REHABILITATION OF OFFENDERS ACT, 1974
The post for which you are applying involves substantial opportunity of access to children. It is exempt from the Rehabilitation of Offenders Act, 1974. You are therefore required to declare any convictions, cautions or bind-overs you may have had, regardless of how long ago and even if they would otherwise be regarded as ‘spent’ under the Act. You are also required to declare any outstanding case(s) against you.
You should be aware that the Foundation will institute its own checks with the Disclosure and Barring Service and the DfE. Please submit information in confidence, enclosing details in a separate sealed envelope. Failure to declare a conviction may disqualify you from appointment or result in summary dismissal if a discrepancy comes to light. A criminal record does not necessarily mean a bar to obtaining a position.
*I have nothing to declare , or:
*I enclose a confidential statement (in a sealed envelope marked ‘Confidential - for the Bursar’)
(*Please delete one of the statements, as appropriate)
I hereby certify that the statements on this form are correct and that no material information is omitted.
Signed______
Date ______
Please ensure that you have filled in the sections on referees at the end of this form.
11. Referees
Please give the contact details of two referees (this should include your last two employers).
One referee should be your current or most recent employer. You must list every employer where the job involved working with children. Where you are not currently working with children but have done so in the past, one referee must be from the employer by whom you were most recently employed in work with children. These referees may be asked questions about disciplinary offences relating to children, including those deemed spent. Please note that references will not be accepted from relatives or from referees writing solely in the capacity of friends. Referees will be asked about your performance and by providing their details you are consenting to this. The Foundation reserves the right to contact any current or previous employer after interview.
Please note that referees may be contacted by telephone and will be invited to submit confidential written references. Referees will normally be contacted before interview. Please indicate here if you do not wish this to happen:
WHERE
First referee
Name: ______
Job title: ______
Address: ______
______Post code ______
Tel No: ______Fax No: ______
E-mail address: ______
Second referee
Name: ______
Job title: ______
Address: ______
______Post code ______
Tel No: ______Fax No: ______
E-mail address: ______
Continuation sheet (if required)
THIS PAGE IS INTENTIONALLY BLANK
12. Equal Opportunities Monitoring Questionnaire
This information contained on the following 3 pages are necessary for equal opportunities monitoring, pre-employment screening and to ensure adequate support at interview. All information will be treated in confidence and will not be seen by staff directly involved in the appointment. The questionnaire will be detached from your application form, stored separately and used only to provide statistics for monitoring purposes. Thank you for your assistance.
The Foundation is committed to providing equal opportunities in employment. This means that all job applicants, employees and workers will receive equal treatment regardless of race, colour, ethnic or national origins, religion, belief, sex, marital status, age, sexual orientation or disability. This policy applies to recruitment, training opportunities, promotion opportunities and employment benefits, discretionary or otherwise. It is the responsibility of everyone in the Foundation to comply with this policy and uphold the principle of fairness in employment.
In order to assess how successful this policy is we have set up a system of monitoring all job applications. We would therefore be grateful if you would complete the questions on this form. We have asked for your name to enable us to monitor applications at shortlisting and appointment as well as application stage.
Name:
Date of Birth:
Post applied for:
1. Do you consider yourself to have a disability, impairment, health condition or learning difference?
Yes No Unsure
Please describe your condition. You may tick one or more of the boxes below or use your own words here:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………......
Physical impairment or condition that affects your mobility, such as an impairment which requires you to use a wheelchair or affects arm movement.
Sensory impairment such as being blind/having a serious visual impairment or being deaf/having a serious hearing impairment.
Mental health condition such as depression or schizophrenia.
Learning difference such as dyslexia.
Learning disability or cognitive impairment such as autism or head-injury.
Long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsy.
Other such as disfigurement (please specify)………………………………….……………………………
Please tell us about any support, help or specific equipment, aides or adaptations you would need at interview.
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………......
2. Gender
Female Male
3. Marital Status
Married/Civil Partner Widowed/Surviving Civil Partner
Single Divorced/Civil Partnership Dissolved
Separated Co-habiting
4. Ethnic Origin
White
/ /Mixed
/British
/ /White and Black Caribbean
/Irish
/ /White and Black African
/Any other white background
/White and Asian
/(please give details)
/ / Any other mixed background(please give details)
/
Asian or Asian British
/ /Black or Black British
/Indian
/ / Caribbean /Pakistani
/ / African /Bangladeshi
/ / Any other black background /Any other Asian background(please give details)
/ / (please give details) /Chinese or Other ethnic group
Chinese
/Other (please give details)
/Do you need any support, assistance or translation help due to a communication barrier e.g. literacy skills or English is not your first language?
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………....
Right to work in the UK
The Immigration, Asylum and Nationality Act 2006 places a duty on all employers to prevent illegal working and requires that employers confirm the right to work in the UK before making an appointment. To assist with this, please give your nationality:
Are you legally eligible for employment within the UK? Yes NoDo you require a work permit to work in the UK Yes No
If you are the preferred candidate and have indicated that you may need aids or adaptations to the workplace or work arrangements, you will be sent a more detailed Health & Medical questionnaire so Occupational Health can provide advice on how to support you in the workplace.
Any false statement or withholding of relevant information may result in dismissal or the withdrawal of an offer of appointment.
1 / Do you have any medical conditions or physical limitations that would require any adjustments in the workplace?
Yes No
If yes, what are the requirements? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
2 / If this post requires you to drive, do you have any medical conditions or physical limitations which could affect your ability to drive?
Yes No
If yes, what are the requirements? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
I hereby certify that the statements on this form are correct and that no material information is omitted.
Signed______
Date ______
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