BRIDGEWATERsCHOOl

drywood hall

Worsley Road, Worsley, Manchester, M28 2WQ

Tel. 0161 794 1463 Fax. 0161 794 3519

Application for Post ofCleaner

(You must complete all boxes.If a box does not apply then write N/A, or if nothing to fill in write NONE)

Mr/Ms/Mrs/Miss/Etc. / Full Name
Male/Female / D.O.B. / Age
Address
Daytime Tel. No. / Evening Tel. No.
Mobile Tel. No. / e-mail Address
National Insurance Number
Where did you see the post advertised?
If you come to interview but are not chosen, would you like to be considered for the same or a similar post if one arose in the near future? Yes/No

Education(use a separate sheet if necessary)

School (11 – 16) / Qualifications gained and dates
Higher/Further Education / Qualifications gained and dates
Other Training/Courses / Qualifications gained and dates

Employment History, starting with most recent

Current Employment / Current Salary(state hours worked weekly)
Address / Position/Responsibilities and dates
Reason for leaving
Previous Employment (supply information dating back at least 5 years. Use separate sheet if necessary. If there is a gap between dates please explain)
Address / Position/responsibilities and dates
Reason for leaving
Address / Position/ responsibilities and dates
Reason for leaving
Address / Position/ responsibilities and dates
Reason for leaving
Address / Position/ responsibilities and dates
Reason for leaving

Referees

Referee 1 (must be your current or last employer)
Name / Address and telephone no.
Referee 2(personal or employer who has known you for at least 2 years)
Name /

Address and telephone no.

Referee 3 (any other you feel is relevant)
Name /

Address and telephone no.

Other Details

Please tell us why you are applying for this job. Please note, the information provided by you in this section is crucial in enabling us to select candidates for interview. Therefore it is important that you give sufficient information to demonstrate that you meet the requirements of the job. Please continue on a separate sheet if necessary.

Interests, hobbies or other information which may support your application

CHILD PROTECTION

Our school is committed to safeguarding its students. Please ensure that you complete this section most carefully:
(a)Do you have any criminal convictions?YES/NO
NOTE: The post is exempt from the Rehabilitation of Offenders Act 1974 and therefore that all convictions, cautions and bind-overs, including those regarded as ‘spent’, must be declared.
(b)Are you on List 99, disqualified from work with children, or subject to sanctions imposed by a regulatory body. YES/NO
(c) Do you have (or have pending) any disciplinary offences relating to children, including any in which the penalty is “time expired”; and/or you have been the subject of any child protection concerns? YES/NO
If you have answered ‘yes’ to any of the above, please attach details of your record in an envelope marked confidential 

DECLARATIONS

1. I confirm that the information supplied by me in this application is complete and correct to the best of my knowledge.
2. I understand that any false information, any relevant omission or misleading statements may disqualify me from employment or result in my dismissal.
  1. I confirm that I am not subject to any immigration controls or restrictions, which prohibit my working in the UK.
  1. I agree that the school reserves the right to require me to undergo a medical examination. (Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor). I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
  1. I agree that should I be successful in this application, the school will, apply to the Disclosure and Barring Service for an enhanced disclosure. I understand that should the disclosure not be to the satisfaction of the school, any offer of employment may be withdrawn or my employment terminated.

Signed……………………………………………….Date……………………………………….

RECRUITMENT MONITORING FORM

All appointments are made on merit. The monitoring form will be detached from the application form before short listing takes place.

We are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of race, colour, ethnic or national origin, religious belief, political opinion or affiliation, sex, marital status, sexual orientation, gender reassignment, age or disability, or is disadvantaged by conditions or requirements which cannot be shown to be justifiable.

In order to monitor the effectiveness and success of this policy please provide the information requested below. The details supplied by you on this form are confidential, but will form part of the personnel record of the successful candidate.

POST APPLIED FOR: ………………………………………… DATE: ……………………………..

GENDER

 female male

ETHNIC ORIGIN

These groupings are in line with the 2001 census. I describe my ethnic origin as:

ASIAN OR ASIANBLACK OR BLACKCHINESE OR OTHER

BRITISH:BRITISH:ETHNIC GROUP:

 Indian Caribbean Chinese

 Pakistani African Other

 Bangladeshi Black

 Asian Other

 Other

WHITEMIXEDOTHER 

 British White & Black CaribbeanPlease specify: ______

 Irish White & Black African______

 White White & Asian______ed or do suffer. ______

 Other Mixed

 Other