38 Burnside Crescent, Langley, Middleton, Manchester, M24 5NN

Tel: 0161 643 5775

Email:

CONFIDENTIAL

Application Form for the post of: Burnside Pre-School Practitioner

27.5hours per week.Starting hourly rate of £7.20Our setting is term time only.

Surname Name: / Other Name(s):
If relevant please state other surname /
family name used previously
Address:
Postcode: / Tel. (Daytime):
Tel. (Evening):
Date of birth:
National insurance number:

Present Employment

If you are not currently employed please fill in your most recent employment or your main activities at that time if more appropriate.

Post held:
Place of work:
Name and address of present or last employer:
Postcode:
Tel.:
Description of current work and types of responsibilities:
If appointed what is the length of notice you are required to give or what is the date you could start this new post?

Previous Employment Background including paid and unpaid

Dates / Name and address
of Employer / Post Held / Nature of job
From
Mth/Year / To
Mth/Year

Education and all training

Please give details of your education and training starting with the most recent and including any formal qualifications or certificates you hold (if any)

Dates / Qualifications / Grades (if applicable) / Name of school or college
From
Mth/Year / To
Mth/Year

Suitability for the job

Please state why you think you are suitable for this job. Enclose additional sheets ifnecessary. You should ensure that you address all the points covered in the person specification.

(This section shouldn’t be more than 2 A4 sides)

Additional Information/Declarations:Please read and complete. How did you first find out about this job?

References:Please state the names and addresses of two people from whom references may be obtained about your suitability for the post for which you are applying. You must supply two references.

1. Present or most recent employer name and address:
Postcode: Tel:
Email:
2. Employment/Personal Capacity (delete as appropriate) name and address:
Postcode: Tel:
Email:

Do you agree to your referees being approached prior to interview? Yes / No

Declarations:

I confirm that I am not subject to any immigration controls or restrictions, which prohibit my working in the UK.

I confirm that the information supplied by me in this application is complete and correct to the best of my knowledge

I understand that any false information, any relevant omission or misleading statements may disqualify me from employment or result in my dismissal.

Print name: Signed: Date:

Rehabilitation of Offenders:

This post involves working with children, young people, vulnerable adults or is a position of trust and is, therefore, exempt from the provisions of the Rehabilitation of Offenders Act 1974. You must, therefore, disclose details of cautions, bind-overs, reprimands, final warnings and convictions, including ‘spent convictions’ and declare if you are on ‘list 99’, disqualified from work with children, or subject to sanctions imposed by a regulatory body. Any failure to disclose such information could result in dismissal or disciplinary action by the organisation. Please note that a criminal record will not necessarily be a bar to obtaining a position.

Have you at any time received, or do you have pending, a caution, bind-over, reprimand, final warning, conviction or other relevant information?

(Please circle) Yes No

Has anyone living in your household at any time received, or have pending, a caution, bind-over, reprimand, final warning, conviction or other relevant information?

(Please circle) Yes No

Print name: Signed: Date:

If so please give details on the following table:

Nature of Offence/s (i.e. Conviction, caution, bind–over, reprimand, warning or allegation)

Offence/s

Date of Offence/s

Disposal (if known)

*If you are filling out and sending this form back electronically, you will be required to sign this declaration if you are invited to the interview stage.

Please email this form to or hand deliver/post this form to:

Burnside Centre

38 Burnside Crescent

Langley, Middleton

Manchester

M24 5NN

The closing date forapplications is:Monday 12noon 22nd August 2016

Interview date: Exact dates TBC but planned for the week beginning 22nd August 2016

We regret that we are unable to acknowledge the receipt of this form because of the high costinvolved. If you receive no further communication within 1 week of the closing date pleaseassume that your application has been unsuccessful. Thank you for your interest in the post.

Burnside Centre is a charity registered in England and Wales

(Registration number 1145309)

Company limited by guarantee registered in England

(Registration number 07536820)