Personal Details

Post Applied For:
Title
Surname
Forename(s)
Address
Telephone No. / Mobile No.
E-Mail Address
NI Number
Are you eligible to work in the UK?
Next of kin
Address
Telephone No.
Do you have a family or close relationship to a member of staff within Sirius Academy North or West, The Constellation Trust or a member of the Governing Body?
If yes, please give name(s) and relationship

Present Post Details

Name and address of current or most recent employer:
Post held (please state if this is perm/temp)
Date of appointment
to organisation / To Post
(if different)
Notice Period
Salary/Allowance Details
Personal Statement
3 sides of A4 maximum. Please use Arial 11pt. This text box will expand as required.

Previous Employment(most recent first)

Name and address of employer / F/T P/T / Position held / Commenced / Completed

Education

Secondary School Attended / Examinations in which successful
(with subjects) / Level / Grade
University or College attended
(with dates) / F/T
P/T / Degrees obtained
(with subjects) / Pass/
Hons / Class or
Division / Year obtained

Other Professional Qualifications

Institution Attended (with dates) / F/T
P/T / Qualifications obtained / Year obtained

Other Experience Relevant to the Post

Criminal Convictions

REHABILITATION OF OFFENDERS ACT (EXEMPTIONS) ORDER 1975

This post is exempt from the Rehabilitation of Offenders Act, 1974 by virtue of the Rehabilitation of Offenders Act, 1974 (Exemptions) Order 1975 as amended. Applicants must declare all convictions, cautions, reprimands or final warnings which for other purposes are “spent” under the provisions of the Act. However, offences which have been removed due to rules for filtering old or minor offences and are now ‘protected’ need not be declared. Further information on the filtering of offences is available at

Any information given will be completely confidential and will be considered only in relation to your application for this post. Any disclosure information revealed will be discussed with you prior to a recruitment decision being made. In the event of employment, any failure to disclose such information could result in dismissal or disciplinary action.

All criminal record information is dealt with in accordance with the Disclosure & Barring Service Code of Practice, a copy of which can be supplied on request.

A criminal record will only bar you from working with us if the circumstances and background of your offence(s) are incompatible with the duties of the post.

Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended?
If you have answered YES above, please state the nature of offence(s) and the date and place of the offence(s):
Are there any matters pending?
Any other names you have used with dates of usage e.g. maiden name, former marriage, change by deed poll:

References

Referees: please provide the name, address and status of two referees; one should have direct knowledge of your professional work.

Referees will normally be contacted before interview. Please indicate here if you do not wish this to happen:

1st Referee / 2nd Referee
Name
(Inc. title)
Status
Address
Tel. No.
(inc. STD)
E-mail address

Any offer of appointment is subject to satisfactory Enhanced Disclosure & Barring Check.

DECLARATION

I declare that the above information is, to the best of my knowledge true and accurate.

SignedDate

For Office Use Only

Date application form received:
Date References Sent
1) 2)
Date References returned
1) 2) / Selected at short-list stage YES/NO
Interview confirmed YES/NO
Interview date: Time:
Selected after interview YES/NO

Completed Application Forms should be returned by email directly to:

EQUAL OPPORTUNITIES

We are working towards equality of opportunity for all who apply for employment with us. We are actively opposed to discrimination and believe that monitoring our recruitment results will help us assess any areas requiring improvement. In order to assist us with this, we would be grateful if you would complete this form and return it with your application. It is in no way connected with your application itself and will be separated from your application form when it reaches our office. We undertake that this form will not be made available to anyone involved in the recruitment and selection of staff and will remain confidential to the Human Resources Department to be used solely for the purpose of monitoring the effectiveness of our equal opportunities policy.

Your help in this matter is entirely voluntary and will in no way affect your application.

Please indicate your gender:

Please indicate your date of birth (dd/mm/yy):

Ethnic origin is not about nationality, place of birth or citizenship. It is to do with colour and broad ethnic group. UK citizens can belong to any of the groups indicated below.

Would you describe yourself as:

African – Black  Chinese 

African – White  Indian 

Asian  Irish 

Bangladeshi  Pakistani 

Caribbean – Black  White 

Caribbean – White  Other (please specify)  ______.

Do you have a disability?

If yes, please give details: ______

______

Are you registered as a disabled person?

How did you hear about this vacancy? (Please specify particular publications/websites if this is relevant)

Post applied for:

The categories listed above are those recommended by the Commission for Racial Equality.

Thank you for your assistance.