APPLICANT NO:

PRIVATE & CONFIDENTIAL

SHEFFIELD DIOCESAN BOARD OF FINANCE

Diocesan Church House 95-99 Effingham Street Rotherham S65 1BL

APPLICATION FORM FOR STAFF APPOINTMENT

Youth and Children’s Worker for the Cantley Churches and Youth Hub Coordinator for the Doncaster Hickleton Chapter Parishes
Please state where you saw the advertisement:
Surname (BLOCK CAPITALS):
Other Names in full:
Title ( Mr Miss Mrs Ms Other):
Permanent Address:
Daytime Telephone Number: / Mobile number:
Email address:
Temporary Address (if applicable):
Eligibility to work in the UK:
Are you a British subject or a national of any EU country? YES / NO
If not, do you have the right to work in the UK and a current work permit? YES / NO
If so, please state the expiry date of your right to work in the UK and/or your work permit:
Do you have access to a motor vehicle? YES / NO
Do you have a full and valid licence? YES / NO
NB. This will only be considered if this requirement is stipulated in the Person Specification.
Applicants to become employees of the Diocesan Board of Finance may not be a member of or promote or solicit support for a party or organisation whose constitution, policy objectives or public statements are declared in writing by the House of Bishops to be incompatible with the Church of England's commitment to promoting racial equality. This explicitly includes the BNP.
Please confirm that you are able to comply with this: YES / NO
THIS APPOINTMENT WILL BE SUBJECT TO SATISFACTORY:
·  REFERENCES
·  DISCLOSURE & BARRING SERVICE (DBS) CLEARANCE (if appropriate / applicable to post)
Disclosure of convictions
Have you ever been convicted of a criminal offence? If so please provide details of any unspent convictions on the separate Disclosure of Convictions form.
Name and contact details of three persons to whom reference can be made (one must be your present or most recent employer):
Full name & job/role title
Post held by you & how known ……………………………………………………..
Email address & tel. no.………………………………………………………………………………………………....
Postal address …………………………………….
Full name & job/role title
Post held by you & how known ……………………………………………………..
Email address & tel. no.………………………………………………………………………………………………....
Postal address …………………………………….
Full name & job/role title
Post held by you & how known ……………………………………………………..
Email address & tel. no. ………………………………………………………………………………………………....
Postal address …………………………………….
References will usually be taken up before interview in the strictest confidence for short-listed candidates (unless you indicate otherwise). We would prefer to contact your referees by email; please check that they agree.
I hereby agree to this:
Signature: Date:
Data Protection:
Information from this application may be processed for purposes registered by the Employer under the Data Protection Act 1998. Individuals have, on written request and on payment of a fee the right of access to personal data held about them.
I hereby give my consent to Sheffield DBF processing the data supplied in this application form for the purpose of recruitment and selection.
Declaration:
I declare that the information given in this application is to the best of my knowledge complete and correct.
Signature: Date:
Note: Any false, incomplete or misleading statements may lead to dismissal.
Secondary Schools attended : / From / To / Details of subjects and examination results
University/College
(and Further Education) / From / To / Details of examination results and qualifications held

PRESENT AND PREVIOUS APPOINTMENTS

Starting with your present appointment, please list what you have done in the course of your career, in reverse chronological order

Dates / Name and address of employer / Position
Held / Brief description of responsibilities / Reasons for leaving
From / To
Taking into account the application pack documentation, please explain why you feel you have the necessary skills and experience for this post. You should include any other information which you feel makes you a suitable candidate for this post in relation to the criteria included in the Person Specification.
(Continue on separate sheet if necessary)

YOU MAY WISH TO ENCLOSE A CURRENT CV IN SUPPORT OF YOUR APPLICATION - ALTHOUGH

A CV ALONE WILL NOT BE CONSIDERED AS A VALID APPLICATION FOR THIS POST

If appointed, when would you be available to take up the post?
Leisure interests, hobbies, etc.
Please return the completed application form, equal opportunities form and disclosure of unspent criminal convictions form by email to .
You will be sent an email confirming receipt of your application.

To comply with the Data Protection Act 1998, application forms, CVs & references for unsuccessful candidates will be shredded after a maximum period of 6 months from interview date

Page 2 of 5

The Diocese of Sheffield

Additional Information – Strictly Confidential

Please return the form to

This information will only be seen by members of staff administrating this vacancy.

Position applied for:
Surname (CAPITALS): /
Title:
Other names in full (CAPITALS):
Disclosure of convictions(s)
Applications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this job will not be taken into account.
You are required to disclose any convictions which are not ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974. Please note that for legal and accounting professions, you are required to disclose all convictions, including those that are ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974.
Have you been convicted of a criminal offence that is not spent? If yes, please give details of date(s), offence(s) and sentence(s) passed (please continue on a separate sheet if necessary).
Dates / Offence / Sentence

Diocese of Sheffield

EQUAL OPPORTUN ITIES MONITORING FORM

The Diocese of Sheffield supports the principle of equal opportunities in employment and opposes all forms of unlawful and unfair discrimination. Our aim is to ensure that job applicants and employees are treated equally and fairly and are recruited, selected, trained and promoted on the basis of job requirements, skills, abilities and other objective and job related criteria. We will also ensure that individuals are not disadvantaged by conditions or requirements which cannot be shown to be justified as being necessary for the safe and effective performance of the job. To assist with this aim and to comply with legislation, we would ask that you please complete and return this form. The information provided will be used solely for monitoring purposes and will not be available to those involved in the selection process.

Name:

Position applied for: Date:

Please ensure that you read all the categories and then place a cross in the box that applies to you.

Ethnic Origin

White

  British

  Scottish

  Welsh

  Irish

  English

  Any other White background: Please state

Mixed Heritage

  White & Black Caribbean

  White & Black African

  White & Asian

  Any other Mixed background: Please state

Asian or Asian British

  Indian

  Bangladeshi

  Pakistani

  Any other Asian Background : Please state

Black or Black British

  Caribbean

  African

  Any other Black background :Please state

Chinese or other ethnic group

  Chinese

  Any other ethnic group: Please state

Disability

The definition of disability as outlined in the Equality Act 2010 is as follows:

“A physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”.

Under this definition, do you consider yourself to be disabled? Yes/No

Gender

Would you describe yourself as:

  Male

  Female

  Prefer not to say

Age Equality

Please mark the relevant box that currently reflects your age status:

  18 or under

  19 to 30

  31 to 50

  51 to 65

  Over 65

  Prefer not to say

Faith /Religion /Belief

Please mark the relevant box that best describes your current status

  Christian

  Buddhist

  Hindu

  Jewish

  Muslim

  Sikh

  None

  Other: Please specify:

  Prefer not to say


Thank you for your co-operation
Please return this form to