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Personal Details Post Applied For: Title Surname Forename(s) Address Telephone No. E-Mail Address NI Number Are you eligible to work in the UK? Next of kin Address Telephone No. Do you have a family or close relationship to a member of staff within the Sirius Academy Multi-Academy Trust or a member of the Governing Body? If yes, please give name(s) and relationship Mobile No. Present Post Details Name and address of current or most recent employer: Post held (please state if this is perm/temp) Date of appointment to organisation To Post (if different) Notice Period Salary/Allowance Details Personal Statement 3 sides of A4 maximum. Please use Arial 11pt. This text box will expand as required. Previous Employment (most recent first) Name and address of employer F/T P/T Position held Commenced Completed Education Examinations in which successful (with subjects) Secondary School Attended University or College attended (with dates) F/T P/T Degrees obtained (with subjects) Level Pass/ Hons Grade Class or Year Division obtained Other Professional Qualifications Institution Attended (with dates) F/T P/T Qualifications obtained Year obtained Other Experience Relevant to the Post Criminal Convictions REHABILITATION OF OFFENDERS ACT (EXEMPTIONS) ORDER 1975 This post is exempt from the Rehabilitation of Offenders Act, 1974 by virtue of the Rehabilitation of Offenders Act, 1974 (Exemptions) Order 1975 as amended. Applicants must declare all convictions, cautions, reprimands or final warnings which for other purposes are “spent” under the provisions of the Act. However, offences which have been removed due to rules for filtering old or minor offences and are now ‘protected’ need not be declared. Further information on the filtering of offences is available at https://www.gov.uk/government/publications/dbs-filtering-guidance Any information given will be completely confidential and will be considered only in relation to your application for this post. Any disclosure information revealed will be discussed with you prior to a recruitment decision being made. In the event of employment, any failure to disclose such information could result in dismissal or disciplinary action. All criminal record information is dealt with in accordance with the Disclosure & Barring Service Code of Practice, a copy of which can be supplied on request. A criminal record will only bar you from working with us if the circumstances and background of your offence(s) are incompatible with the duties of the post. Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended? If you have answered YES above, please state the nature of offence(s) and the date and place of the offence(s): Are there any matters pending? Any other names you have used with dates of usage e.g. maiden name, former marriage, change by deed poll: References Referees: please provide the name, address and status of two referees; one should have direct knowledge of your professional work. Referees will normally be contacted before interview. Please indicate here if you do not wish this to happen: 1st Referee 2nd Referee Name (inc. title) Status Address Tel. No. (inc. STD) E-mail address Any offer of appointment is subject to satisfactory DBS check. Enhanced Disclosure & Barring Check. DECLARATION I declare that the above information is, to the best of my knowledge true and accurate. Signed Date Selected at short-list stage YES/NO For Office Use Only Date application form received: Date References Sent 1) YES/NO Interview date: Time: Selected after interview YES/NO 2) Date References returned 1) Interview confirmed 2) Completed Application Forms should be returned by email to: [email protected] EQUAL OPPORTUNITIES We are working towards equality of opportunity for all who apply for employment with us. We are actively opposed to discrimination and believe that monitoring our recruitment results will help us assess any areas requiring improvement. In order to assist us with this, we would be grateful if you would complete this form and return it with your application. It is in no way connected with your application itself and will be separated from your application form when it reaches our office. We undertake that this form will not be made available to anyone involved in the recruitment and selection of staff and will remain confidential to the Human Resources Department to be used solely for the purpose of monitoring the effectiveness of our equal opportunities policy. Your help in this matter is entirely voluntary and will in no way affect your application. Please indicate your gender: Please indicate your date of birth (dd/mm/yy): Ethnic origin is not about nationality, place of birth or citizenship. It is to do with colour and broad ethnic group. UK citizens can belong to any of the groups indicated below. Would you describe yourself as: African – Black African – White Asian Bangladeshi Caribbean – Black Caribbean – White Chinese Indian Irish Pakistani White Other (please specify) _________. Do you have a disability? If yes, please give details: _______________________________________________ _________________________________________________________________ Are you registered as a disabled person? How did you hear about this vacancy? (Please specify particular publications/websites if this is relevant) Post applied for: Sirius Academy West, Hull The categories listed above are those recommended by the Commission for Racial Equality. Thank you for your assistance.