ST. IVES TOWN COUNCIL

Confidential

Job Application Form:

Facilities Manager (Part time, permanent)

Please answer all questions. Additional sheets may be added if necessary to fully complete answers.

Position applied for / Facilities Manager
Surname
First names and title
Address
Telephone
Email
National Insurance Number

If telephone / email contacts are your work contacts, please state this, and advise whether we may contact you at work.

Do you require a work permit to take up employment in the UK? Yes/No

Do you hold a current clean driving licence? Yes/No

Do you have any disabilities which are relevant to your application? Yes/No

If yes, please give brief details of the disability plus provision needed to help with an interview and employment.

Do you have any convictions that are unspent under the Rehabilitation of Offenders act 1974? Yes/No

If yes, please give details / dates of offence(s) and sentence:

Present Employment (if not applicable, please state why)

Name of employer
Address
Post title
Date of appointment
Brief description of duties
Period of notice

Previous Employment (Please list all previous employment in reverse chronological order, starting with most recent)

Date from / to / Position held / duties / Name and address of employer / Reason for leaving

Education (since age 11)

Date from / to / Name of school, college or university / Qualifications gained

Training

Organising Body / Course Title / Duration / Date

References

Please give the names and addresses of two referees. One should be your present or last employer if possible.

Referee 1 / Referee 2
Name / Name
Post Title / Post Title
Address / Address
Telephone / Telephone
Do you wish to be consulted before we approach Referee 1? Yes/No / Do you wish to be consulted before we approach Referee 2? Yes/No

Please explain how you meet the requirements in the job description and person specification. You may draw on knowledge, skills, abilities, experiences etc gained from paid work, unpaid work, domestic responsibilities, education, leisure interests and voluntary work.

Please give your reasons for applying for this post and details of any outside interests or other information which will support your application.

MEDICAL ENQUIRY FORM

You may contact the Town Clerk if you have any questions regarding your rights under the Access to Medical Records Act 1988

Delete the answer which does not apply

1. / Are you in good health? / Yes / No / If ‘No’, please give details.
2. / Do you have any health issues which may affect your ability to commit to a regular pattern of work? / Yes / No / If ‘Yes’, please give details.
3. / How many days sickness absence have you had in the past 12 months? / (Details may be given if relevant)

Name and address of your GP:

Are you related to any Councillor or employee of the Council? Yes / No

If yes, please give details.

Under the Working Time Regulations 1998, the Council must monitor the hours worked by its employees. Please confirm whether this will be your only employment. If not, please provide details.

DECLARATION

I declare that the information given in this application is correct to the best of my knowledge. I understand that if I knowingly provide false information or canvass for the appointment, this will result in my disqualification or dismissal after appointment.

Signed ...... Date ......

Please return your completed application form to:

Louise Dowe

Town Clerk, St Ives Town Council

The Guildhall

Street An Pol

St Ives, Cornwall

TR26 2DS

Or email to :

Closing Date: 4pm, Friday11September 2015

In accordance with the Data Protection Act 1998 all information given on this application form will only be used to determine an applicant’s suitability for the job and will be kept only for those purposes.

Application forms for unsuccessful candidates will be retained for a period of six months before being destroyed.