CONFIDENTIAL

Application for appointment of: / Shire Hall Learning Manager
Date of advertisement: / April 2016
Where did you see this post advertised?

PERSONAL DETAILS

Surname / Forenames
Address
Tel. no. / Mobile no.
E-mail

SECONDARY AND SUBSEQUENT EDUCATION

School, College, University, etc. (full or part time) including dates / Course of Study pursued and academic qualifications obtained (state subjects and grade)

MEMBERSHIP OF PROFESSIONAL ORGANISATIONS

Organisation / Membership status / Since

PRESENT/MOST RECENT EMPLOYMENT

Name and address of employer
Job title
Present salary
Notice period required
Please give a brief description of present duties and responsibilities:

PREVIOUS EMPLOYMENT

In chronological order and including any temporary experience, most recent employment first.

Name and address of employerand dates of employment / Job title / Reason for leaving
SUPPORTING STATEMENT
Use the box below to demonstrate clearly how you meet the requirements of the Person Specification section of the Job Description by setting out details, with examples where relevant, of your relevant experience, knowledge and skills. Attach extra sheets if necessary.
If the job requires you to have a driving licence and/or transport available for work, please fill in the following:
Do you have a full current driving licence? / YesNo
Will you have transport available for work? / YesNo / If yes, what sort?

ELIGIBILITY TO WORK IN THE UK

Any appointment is subject to the relevant permits and visas being obtained.

Do you require a work permit? / Yes / No

REFERENCES

One should be your present employer or your last employer if you are not currently employed.

Name / Name
Position / Position
Address / Address
Relationship / Relationship
Tel. no. / Tel. no.
E-Mail / E-Mail
If necessary may we contact this referee before interview? / If necessary may we contact this referee before interview?
Yes / No / Yes / No

DECLARATION

By ticking this box, I declare that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions could disqualify me from employment or later dismissal, if appointed. I declare that I have not canvassed any member of the Shire Hall Dorchester Trust, and will not do so.
Signed: Date:
Warning. This job may have substantial access to children and/or vulnerable adults. If we offer you the job, you will need a DBS check. We will withdraw the offer if the check highlights something about you that we assess would make you unsuitable for the job. We take criminal records into account only when the conviction is relevant. Failing to disclose a conviction, caution or binding-over may result in your application being disqualified. If we discover evidence of this after your appointment, we could dismiss you without notice.

DATA PROTECTION

We will treat all information you provide in confidence and in accordance with the Data Protection Act 1998. We will hold it electronically, and keep it secure. We will use it for the purpose of helping our recruitment process and for payroll and administration purposes if your application is successful. We will share it with others involved in the recruitment process. We will not disclose it to other organisations or use it for any other purpose without your explicit consent. If you are unsuccessful, we will destroy your application form and any other papers you have submitted six months after we have made the appointment. We will only hold information beyond six months with your consent.
Completed forms should be marked “In Confidence” and returned, by 5pm on Friday 29th April 2016 to:
Anna Bright, General Manager, Shire Hall
c/o South Walks House, South Walks Road, Dorchester, Dorset DT1 1UZ
or e-mailed to

1

- -