ࡱ>  &    &;bjbj>!>! 4D\K?k\K?kUEc 89 EOZ#ZS+S+S+k+,#/\0;O=O=O=O=O=O=ORRUP=Ou/1,,/1/1=OS+k+4O)5)5)5/1RS+k+;O)5/1;O)5)5HJS+o4k1I'OO0OIXUK2rXU,JXUJ(/1/1)5/1/1/1/1/1=O=O3l/1/1/1O/1/1/1/1XU/1/1/1/1/1/1/1/1/1 :  Extol Trust Staff Application Form CONFIDENTIAL - The information you provide on this form will be used for recruitment, selection and for employment contract purposes. KEEPING CHILDREN SAFE IN EDUCATION Extol Trust is committed to ensure that all children within our trust are safe and their wellbeing ensured. We are therefore fully compliant with the requirements set out within Keeping Children Safe in Education legislation and Safer Recruitment processes. This includes completing online searches for shortlisted candidates as part of our due diligence. EQUAL OPPORTUNITIES Extol Trust is committed to being an equal opportunities employer and promote an environment that is free from discrimination. Extol Trust promotes equality in respect of age, disability, pregnancy, sexual orientation, race, gender, marital status, domestic circumstances, carer responsibilities, religion or belief. Please complete this application in black ink or type and return to the school at the following address: 91Ƶ Marsh House Avenue Billingham TS23 2HJ Applications can also be returned by email to: roseberry@roseberryprimary.org.ukPOST APPLIED FOR (It is essential that candidates complete all details in this box so their application can be considered.)Job Title FORMTEXT      Trust/School FORMTEXT      Closing Date FORMTEXT      PART A: PERSONAL DETAILS Surname / Family Name FORMTEXT      Previous Surname / Family Name FORMTEXT      Forenames or Initials FORMTEXT      Address: FORMTEXT        FORMTEXT       Resident at this address since FORMTEXT      Town / City FORMTEXT      Post Code FORMTEXT      NI Number FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT  Contact Phone Number FORMTEXT      Email Address * FORMTEXT      * We would prefer to contact you by email throughout the recruitment process, please provide an email address if possible PART A: PERSONAL DETAILS ContinuedAre there any restrictions to your residence in UK which may affect your right to take up employment in the UK? If so, please provide details in the additional information box.YES  FORMCHECKBOX  NO  FORMCHECKBOX If you are successful in your application, would you require a work permit prior to taking up employment? If so, please specify dates in the additional information box.YES  FORMCHECKBOX  NO  FORMCHECKBOX Have you ever lived or worked outside of the UK? If so, please provide details in the additional information box.YES  FORMCHECKBOX  NO  FORMCHECKBOX Do you hold a Certificate of Good Conduct/Criminal Record Check/Police Certificate or equivalent for your time spent abroad? If yes, please provide the date of issue in the additional information box YES  FORMCHECKBOX  NO  FORMCHECKBOX  Additional Information: Please use this section to expand on any of the questions in Part A above.   PART B: REFERENCES References for ALL shortlisted candidates will be requested prior to interview Please see notes below before completingReference 1 (Current/Most Recent Employer)Reference 2 (Employer prior to current/most recent)Referee s Name FORMTEXT       FORMTEXT      Job Title FORMTEXT       FORMTEXT      Name/Address of organisation  FORMTEXT        FORMTEXT       Email of organisation FORMTEXT       FORMTEXT      Telephone number of organisation FORMTEXT       FORMTEXT      Please note: At least TWO references for ALL shortlisted candidates will be requested prior to interview. However, we may need to take up additional references from any previous employer. We will contact you for further information if we need to do so. Open references (to whom it may concern) will not be accepted. To ensure the validity of the organisation, the email address of a referee should always be directed to the work / organisation email and not to a private email address. Referees should be an employer (i.e. manager) and not co-workers. PART C: INFORMATION IN SUPPORT OF APPLICATION Current Employer Please provide details of your current employer.Name & Address of employerJob RoleSalaryStart DateReason for Leaving Brief Description of Duties Employment Record - Please provide details of your full employment history, most recent first. (more boxes can be added if required)Name & Address of EmployerDates from / to (Month & Year)Job Title, Brief Description of Duties & SalaryReason for Leaving     Please identify and provide details of any gaps in employment history when you have not been in education, training or employment (exceeding 4 weeks)   Educational & Vocational Qualifications - Please provide details (including dates) of qualifications achieved. Please include qualifications such as GCSEs, A-levels, Higher Education and Apprenticeships.QualificationGradeDate ObtainedSchool/College/ University/ProviderContinuous Professional Development - any other training that supports your application, suitability for the role and demonstrates your continuous professional development.CourseDate ObtainedProviderProfessional Memberships - Please provide details (including membership number and level).  PART D: SUPPORTING EVIDENCE Additional Information in support of your application Please read the Job Description and Person Specification carefully; then explain how your knowledge, skills and experience relate to the post for which you are applying. These may have been gained through paid employment, domestic responsibilities, voluntary/community work, spare time activities, education and training.   PART E: DECLARATIONS AND CONSENTS Are there any reasonable adjustments that you would require to enable you to participate in the interview/assessment event if you were selected to attend? Are you related to any member or employee of Extol Trust?Yes  FORMCHECKBOX  No  FORMCHECKBOX If you answered Yes, please provide details Are you related to a member of the Local Governing Body?Yes  FORMCHECKBOX  No  FORMCHECKBOX If Yes, please provide name(s) & relationship: I understand that canvassing of any Governors, Trustees and/or Members of Extol in connection with this appointment will disqualify me.Yes  FORMCHECKBOX  No  FORMCHECKBOX  Has any previous employer expressed concerns and/or taken any action, whether informal/ formal (including suspension from duty) on the following: (Include any investigations or actions taken by your professional body)Capability or work performanceYes  FORMCHECKBOX  No  FORMCHECKBOX Please provide details: DisciplinaryYes  FORMCHECKBOX  No  FORMCHECKBOX Please provide details: You are only required to declare live disciplinary sanctions unless they relate to safeguarding (see below)SafeguardingYes  FORMCHECKBOX  No  FORMCHECKBOX Please include details of any substantiated allegations which have been made against you and how these have been categorised. Any disciplinary sanctions relating to safeguarding must also be declared, including those which have expired for disciplinary purposes. Are there any dates when you would not be available for interview in the near future?Yes  FORMCHECKBOX  No  FORMCHECKBOX Please provide details: Please state the date on which you could take up duty if appointedDo you hold a current driving licence?Yes  FORMCHECKBOX  No  FORMCHECKBOX Driving licence numberDriving licence typePaper  FORMCHECKBOX  Photo  FORMCHECKBOX Date valid from (DD/MM/YY)Issue CountryWhat type of licence is it? (e.g. full, provisional, HGV, PSV)Do you have use of a car?Yes  FORMCHECKBOX  No  FORMCHECKBOX I declare that the information contained in this application form is correct and understand that the school will request to see proof of qualifications at the time of interview. Yes  FORMCHECKBOX  No  FORMCHECKBOX I consent to Extol Trust recording and processing the information detailed in this application. Extol Trust will comply with their obligation under the Data Protection Act 2018.Yes  FORMCHECKBOX  No  FORMCHECKBOX We advise applicants that the data held by Extol Trust in respect of employment will be used for cross-system comparison purposes for the prevention & detection of fraud. To find out about how we use your personal data for the purposes of recruitment please see our Privacy Notice at www.extoltrust.co.uk/privacy-statement/ Rehabilitation of Offenders The post you are applying for requires you to have an enhanced Disclosure and Barring Service criminal records check for work with children, with a barred list check if you work in regulated activity. This check for disclosure of criminal history will include spent convictions, pending prosecutions / current court proceeding and police enquiries. Should you be shortlisted, you will be asked to disclose full details of your criminal history prior to your interview. This information may be discussed with you at your interview in order to assess job related risks, but we emphasise that your application will be considered on merit and ability and you will not be discriminated against unfairly. Failure to disclose this information will result in any offer of employment being withdrawn. Please also see the Policy Statement on the Recruitment of Ex-offenders (Appendix 2) A Criminal Record Check / Barring List Check will be made only in the event of you being offered the post. An offer of employment made in this way is called a conditional offer. A criminal record will not necessarily be a bar to obtaining a post and applicants will not be unfairly discriminated against on the basis of information received through the disclosure process I understand that a medical examination may be necessary in connection with this post and that my appointment would be subject to satisfactory medical clearance.  FORMCHECKBOX  I understand that any offer of employment is subject to obtaining two satisfactory references  FORMCHECKBOX  I understand that any offer of employment is subject to obtaining a satisfactory enhanced DBS check.  FORMCHECKBOX  I understand that it is an offence to apply for a post which is classified as Regulated Activity if I am barred from applying for such a post.  FORMCHECKBOX  If shortlisted, I will provide the trust additional details of the above barring information, any sanctions, record of convictions, cautions or bind-overs in a separate envelope  FORMCHECKBOX  I declare that the information that I have given in this application is accurate and true.  FORMCHECKBOX  I understand that providing misleading or false information will disqualify me from the appointment OR if appointed may result in disciplinary action including dismissal.  FORMCHECKBOX SignedDate Appendix 1 RECRUITMENT & EQUAL OPPORTUNITIES MONITORING Personal data supplied on this form may be held and/or verified by reference to information already held electronically (Data Protection Act 1998). Information provided by you in this application form will only be used in relation to your application. Once the recruitment process is completed, your form will be stored for a maximum of 6 months and then destroyed. Equal opportunity monitoring data is kept for 5 years to help us monitor our recruitment process. If you are appointed, relevant information will then be taken from this application form and used as part of your personnel record. Completion of this form is taken as acceptance of these conditions. Surname/Family NameJob Title:Forenames or Initials GenderEthnic OriginFemale FORMCHECKBOX WhiteMale FORMCHECKBOX British FORMCHECKBOX  Non-Binary / Non - Conforming FORMCHECKBOX Irish FORMCHECKBOX Trans-Gender FORMCHECKBOX White Other FORMCHECKBOX  Prefer not to say  FORMCHECKBOX Asian or Asian BritishBangladeshi FORMCHECKBOX  Sexual OrientationIndian FORMCHECKBOX  Bisexual  FORMCHECKBOX  Pakistani FORMCHECKBOX  Gay Man FORMCHECKBOX  Any Other Asian FORMCHECKBOX  Gay Woman / Lesbian FORMCHECKBOX  Black and Black BritishHeterosexual FORMCHECKBOX African FORMCHECKBOX Prefer not to say FORMCHECKBOX Caribbean FORMCHECKBOX  Any Other Black FORMCHECKBOX  Age Band Mixed16-24 years FORMCHECKBOX White & Asian FORMCHECKBOX 25-34 years FORMCHECKBOX White & Black African FORMCHECKBOX 35-49 years FORMCHECKBOX White & Black Caribbean FORMCHECKBOX 50-54 years FORMCHECKBOX Any Other Mixed FORMCHECKBOX 55 and over years FORMCHECKBOX OtherPrefer not to say FORMCHECKBOX Chinese  FORMCHECKBOX  Any Other  FORMCHECKBOX  Do you consider yourself to have a disability?Prefer not say  FORMCHECKBOX  Yes FORMCHECKBOX No FORMCHECKBOX Religion / BeliefPrefer not say FORMCHECKBOX Buddhist FORMCHECKBOX  Christian  FORMCHECKBOX  Where did you see the post advertised?Hindu FORMCHECKBOX  Specialist Publication FORMCHECKBOX Jewish FORMCHECKBOX  Sector 1 Website FORMCHECKBOX Muslim FORMCHECKBOX  North East Jobs Website FORMCHECKBOX Sikh FORMCHECKBOX  School / Trust Website FORMCHECKBOX Other FORMCHECKBOX  TES FORMCHECKBOX None FORMCHECKBOX  Casual Enquiry FORMCHECKBOX Prefer not to say  FORMCHECKBOX  Word of Mouth FORMCHECKBOX  Other FORMCHECKBOX Appendix 2 POLICY STATEMENT ON THE RECRUITMENT OF EX-OFFENDERS As an organisation assessing applicants suitability for positions which are included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order using criminal record checks processed through the Disclosure and Barring Service (DBS), this school complies fully with the DBS  HYPERLINK "https://www.gov.uk/government/publications/dbs-code-of-practice" code of practice and undertakes to treat all applicants for positions fairly. This school undertakes not to discriminate unfairly against any subject of a criminal record check on the basis of a conviction or other information revealed. This school can only ask an individual to provide details of convictions and cautions that it is legally entitled to know about. Where a DBS certificate can legally be requested (where the position is one that is included in the Rehabilitation of Offenders Act 1974 (Exceptions) order 1975 as amended, and where appropriate Policy Act Regulations as amended) this school can only ask an individual about convictions and cautions that are not protected. This school is committed to the fair treatment of its staff and potential staff, regardless of age, marital status, race, gender, religion, sexual orientation, responsibilities for dependents, pregnancy, physical/mental disability, medical history or offending background. 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/KC]C^CpC $Ifgd=p$$Ifa$gd=ppCqCC0% $Ifgd=pkd$$Ifl\H(0h0 `(0(64 lap(yt /CCCCC $Ifgd=p$$Ifa$gd=pCCCCCCCCCCCCCCCCCCCCCCDDwgwU#h}uh=p5CJOJQJ^JaJh}uhQ 5CJOJQJ^Jh}uh=p5CJOJQJ^J/jh}uh=pCJOJQJU^JaJ h}uh}uCJOJQJ^JaJ h}uh=pCJOJQJ^JaJ h}uh=pCJOJQJ^JaJ)jh}uh=pCJOJQJU^JaJ/jbh}uh=pCJOJQJU^JaJCCkd$$Ifl4r(#H(0`h  (0(64 laf4p(yt /CCCCC $Ifgd=p$$Ifa$gd=pCCCCC8--- $Ifgd=pkd$$Ifl4\(#H( h  0(64 laf4pyt /DDDDDD*D+D9D:D;D*CJOJQJ^JaJ&h}uhMQ6>*CJOJQJ^JaJ/jh}uhQ CJOJQJU^JaJ h}uhQ CJOJQJ^JaJ)jh}uhQ CJOJQJU^JaJ h}uhQ CJOJQJ^JaJ h}uh}uCJOJQJ^JaJ hgdhQ CJOJQJ^JaJ hgdhgdCJOJQJ^JaJhgdCJOJQJ^JaJEEE-" $Ifgd=pkd]$$Ifl4\H(0 h`0 (0(64 laf4p(yt /EEEE $Ifgd=p$$Ifa$gd=pEEE!F/*"$a$gd!gdMQkd%$$Ifl4\H(0h 0 (0(64 lap(yt /EE F!F"FG8G9GGGGGGGwHxHI>J?J±iXG6 h}uhnCJOJQJ^JaJ h}uh XCJOJQJ^JaJ h}uh!CJOJQJ^JaJ6jh}uh!0JB*CJOJQJU^JaJph-h}uh!0JB*CJOJQJ^JaJph)jh}uh!CJOJQJU^JaJ h}uh!CJOJQJ^JaJ&h}uh!5>*CJOJQJ^JaJ(h}uh X>*B* OJQJ^JaJph `(h}uh!>*B* OJQJ^JaJph `!F"FGGwHxH>J?JQKRKKKpMqM}r gdVy? & F ^`gdVy? ^`gd! & F ^`gdngdn & F ^`gd X gd X & F ^`gd!gd! ?JJJK KK%K6KOKPKQKRKKKKLMpMqM455U6V6W6 7!7"77k8l8m888%9&9IJ됡됐}됡됡됡hh)jh}uh!CJOJQJU^JaJU h}uhVy?CJOJQJ^JaJ h}uh!CJOJQJ^JaJ h}uh!CJOJQJ^JaJ#h}uh!CJOJQJ]^JaJ#h}uhQ CJOJQJ]^JaJ(h}uhnCJOJQJ^JaJmH sH (h}uh!CJOJQJ^JaJmH sH #A disclosure is only requested from the DBS after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. For those positions where a criminal record check is identified as necessary, all application forms, job adverts and recruitment briefs will contain a statement that a DBS certificate will be requested in the event of the individual being offered the position. This school ensures that all those who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. This school also ensures that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974. At interview, or in a separate discussion, this school ensures that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment. This school makes every subject of a criminal record check submitted to DBS aware of the existence of the  HYPERLINK "https://www.gov.uk/government/publications/dbs-code-of-practice" code of practice and makes a copy available on request. This school undertakes to discuss any matter revealed on a DBS certificate with the individual seeking the position before withdrawing a conditional offer of employment. (Source  HYPERLINK "https://www.gov.uk/government/publications/dbs-sample-policy-on-the-recruitment-of-ex-offenders/sample-policy-on-the-recruitment-of-ex-offenders" www.gov.uk)     OFFICIAL SENSITIVE  qM55V6W6!7"7l8m8_9`9 : ::::::::::gd5*9< ^`gd! ^`gd! & F ^`gd!&96979^9_9`99 : : ::::::įx^I^.5h}uh!0JB* CJOJQJ^JaJmH phpsH )h}uh!B* CJOJQJ^JaJphp2jh}uh!B* CJOJQJU^JaJphp(h}uh!CJOJQJ^JaJmH sH  h}uh!CJOJQJ^JaJ h}uh!CJOJQJ^JaJ(h}uh!CJOJQJ^JaJmH sH >jh}uh!0JB*CJOJQJU^JaJmH phsH 5h}uh!0JB*CJOJQJ^JaJmH phsH :::::::::::::::::::;;;;;";#;$;%;&;˺uqmmihh5hh~6 j1helhgdUmHnHuhgphgdB*CJphhgdjqhgdUhjhUh}uh!OJQJ^JaJ h}uh!CJOJQJ^JaJ(h}uh!CJOJQJ^JaJmH sH >jh}uh!0JB* CJOJQJU^JaJmH phpsH :::;;;#;$;%;&;skg<$a$gdh~6ikdO$$IflF| e* > t+6    44 laPytgp $$Ifa$gdgp $$Ifa$gdgp $Ifgdgd 21h:pgd. 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