FOR OFFICE USE Date sent out: Date returned: Application no: Closing date:

This school is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment. This school is committed to equal opportunities in employment and we positively welcome your application irrespective of your gender, race, disability, colour, ethnic or national origin, nationality, sexuality, gender identity, marital status, responsibility for dependants, religion, trade union activity and age. Successful applicants will be required to undertake an Enhanced DBS check. Please complete all sections on the form. If any section does not apply to you, enter not applicable (n/a). It is important that you refer to the Guidance Notes before completing this form. This form is also available in large print, Braille or on audio tape on request.

1. VACANCY DETAILS
Job title: Cover Supervisor School/Establishment: Wheelers Lane

2. PERSONAL DETAILS
Last Name: Rana Any Previous Name/s: Date of birth: 08/11/77

First Name(s): Padmini Title e.g. (Mr,Mrs,Miss,Ms): Miss Postcode: B19 1QL Daytime Tel: 0121 2416990 Mobile Tel No: Address: 45 Wills Street, Lozells, Birmingham

Evening Tel: Email Address: pammie78@hotmail.com

Please indicate if you are happy to receive correspondence via your email address. E.g. invite to interview letter Yes: x No: National Insurance Number, if you have one: Do you have the right to work in the UK? JW775618C Yes: X No:

Please note: Original identification documents verifying your right to work in the UK will be requested, checked and a photocopy will be taken. If your application is successful and you commence employment, the copy of your identification documents will be retained on file under regulations governed by the Immigration, Asylum and Nationality Act. Current driving licence (if this is a requirement of this job) Yes: X No:

3. GENERAL INFORMATION
Are you related to or do you have a close relationship with: A Birmingham Councillor; Birmingham School Governor; an employee of the school to which you are applying, or an employee of Birmingham City Council? If yes, please provide details: Name: Relationship: No: X Position: Directorate: Yes: Yes: No: X

Do you wish to job share the position you are applying for?

4. ARRANGEMENTS FOR INTERVIEW

Yes: No: X

If you have a disability, are there any arrangements which we can make for you if you are called for interview and/or work based exercise? If yes, please specify (e.g. ground floor venue, sign language interpreter, audio tapes, etc.)

5.
From Mth 09 Yr 89

EDUCATION/QUALIFICATIONS (start with secondary first)

To Mth 06 Yr 94 Secondary school/College/University, etc. Examinations taken or to be taken Holte Secondary School, Wheeler Street, Newtown. B19 2ep GCSE Media Studies (b) English Language (c) English Literature (c) Science (c) Geography (c) Results and Grades Date gained

1994

09/

94

06

97

Matthew Boulton College, Sherlock Street, Birmingham

a-levels:

psychology (c) History (e) Religious studies (c)

1996

1997

Gcse

Maths (c)

01

20 08

02

20 10

Wolverhampton

Diploma

Physician Assistant Studies

2010

6.
Year 2010

TRAINING

(most recent first)

Course title Basic First Aid Length of course 1 day

Organising body Advantage Health Care

 7. MEMBERSHIP
Please indicate membership of any organisation/s relevant to this position Name of organisation Type of membership Date of membership

8.
Please

PAST EMPLOYMENT & EXPERIENCE (most recent first)

complete the following, in full chronological order, starting with your current

employment/experience. For safeguarding purposes, it is essential that all gaps in your employment history are fully accounted for. Please also include any breaks in employment history together with the reason for the break. From Mth 06 Yr 20 12 To Mth Yr Deeset Casual store development advisor It is seasonal work Employer Job Title Reason for change

01

20 12

05

20 12

Career Break

I went travelling to Mount Everest

09

20 10

12

20 11

National Health Service

Physician Assistant

It was the end of the contract

05

20 10

08

20 10

University of Wolverhampton

Library Support Assistant

It was a temporary contract and I started a new job

01

20 04

01

20 08

Birmingham City Council

Benefit Officer

I started a full time course

06

20 02

01

20 04

Birmingham City Council

Administrative Assistant

I started a new job

9.

PRESENT AND MOST RECENT EMPLOYMENT

Employer: Royal Mail

(if any) Salary:

Job title:Royal Mail Casual 6.19 p.h Date Started: 03/12/12 Address: Angard
1st Floor Charles House 61-69 Derngate Northampton

Date left (if applicable):

Post code: NN1 1UE

Reason/s for leaving (if applicable):

10. ILL HEALTH RETIREMENT/DISMISSAL

Have you ever taken ill health retirement from Birmingham City Council? If yes, date: Name of Department: Have you ever been dismissed from a school for misconduct? If yes, date: Name of school and LA: Please attach full details of the reason for the dismissal in a sealed envelope marked Private and Confidential and return with you application. Have you ever been dismissed for misconduct from a Birmingham City Council Department? If yes, date: Name of school and LA: Yes: No: x Yes: Yes: No: x No: x

Please attach full details of the reason for the dismissal in a sealed envelope marked Private and Confidential and return with you application. (Please be assured that providing this information will not necessarily bar you from employment)

11. WRITTEN REFERENCES

Please give the name of two referees, one of whom should be your current or most recent employer. If this employment has been within a school, this would normally be your head teacher or appropriate line manager. If you are not currently working with children, but have previously done so, one referee must be the most recent employer who employed you to work with children. Written references will not be accepted from relatives or people writing solely in the capacity of friends.

Name: Dr Hassan Paraiso Address: Dudley Group of Hospitals, NHS foundation Trust, Russells Hall Hospital, Pensnett Road Postcode: DY1 2HQ Telephone Number: 01384 456 111 Email: adele.robinson@dgoh.nhs.uk Fax Number: Relationship to You: My Manager. Im known as Priya Rana ____________________________________________________________________________________ Name: Dr Mohan Thomas Address: Dudley Group of Hospitals, NHS foundation Trust, Russells Hall Hospital, Pensnett Road, Dudley Telephone Number: 01384 456 111 Email: Fax Number: Relationship to You: Mentor and manager Postcode: DY1 2HQ

12. OTHER RELEVANT INFORMATION IN SUPPORT OF YOUR

APPLICATION
(No more than 3 sides of A4 paper in total)
I have several years of experience working in the administrative/clerical field. In those roles my duties were made up of tasks such as typing documents, inputting data, emailing, filing, faxing, photocopying, and contacting clients, agencies, and departments through written contact or phone. Throughout my working career I have used different in house computer systems. I am computer literate and capable of using software packages such as Word, Excel, Powerpoint, and Internet. In my previous role as a Physician Assistant in a busy hospital my role entailed obtaining a detailed history from patients, relatives and carers. It was vital to have good listening, written and verbal skills. I also noted my consultants diagnosis, treatment, and plans. Hence it was essential that I had accurate and legible handwriting. In addition to this I was expected to follow detailed instructions and report back any issues. For example when ordering tests, investigations, as well as communicating with other health care professionals. This gave me lots of experience of working within a team and also the ability to work unsupervised. I worked with people of all ages, including children, people with special needs, and other members of the general public. This required me to have a calm, professional manner as well as the ability to remain flexible. I am able to manage my workload, and have done this on many occasions, such as when I was working in Hospital, and had to arrange an urgent scan whilst making sure my other jobs were completed. This was also the case when working as a benefit officer, and claims had to be processed. This led me to develop my organisational skills and multitask efficiently. Working in a busy hospital with a diverse clientele, it was vital that I understood and adhered to the policies and procedures such as confidentiality, health and safety, equality and diversity.

12.OTHER RELEVANT INFORMATION IN SUPPORT OF YOUR APPLICATION CONTINUED


13.

DATA PROTECTION ACT 1998 Consent and Certification of

Details
The information collected on this form and other information which constitutes your personnel record will be used in compliance with the Data Protection Act 1998. The information is being collected for the purpose of administering the employment and training of employees. The information may be disclosed, as appropriate, within the City Council, to governors of schools, to Occupational Health, Law Enforcement Authorities, the West Midlands Metropolitan Authorities Pension Fund, pension providers and relevant statutory bodies. You should also note that because we have a duty to protect the public funds we handle, we might need to use the information you have provided on this form to prevent and detect fraud. We may also share this information for the same purposes with other organisations, which handle public funds. I, (print name) Padmini Rana consent to my employer recording and processing the information detailed in this application form. I understand that this information may be used by my employer in pursuance of its business purposes and my consent is conditional upon my employer complying with their obligations under the Data Protection

Act 1998. Application forms of unsuccessful candidates will be destroyed after six months following an appointment to the job.

14. CONFIRMATION OF DETAILS

I hereby certify that all the information given on this form is correct and that all questions related to me have been accurately and fully answered, and that I am in possession of the certificates I claim to hold. I understand that should the information given in this application be incorrect it may result in my application being rejected, or if selected for the position, summary dismissal, and possible referral to the police. Signature: P.Rana Date: 28/01/2013 Print Name: Padmini Rana If you are making your application in Braille or on audio tape you must declare that you have read and understood this section and that the information you have given is true and correct at the time of completion. You may also be required to sign a declaration to this effect at a later date.

15. DISCLOSURE
Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 IMPORTANT NOTE FOR ALL PERSONS APPLYING FOR POSITIONS IN SCHOOLS AND COLLEGES, AND OTHERS WHO WILL WORK WITH YOUNG PERSONS UNDER AGE 18 The Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 does not allow employees with access to children and young persons under the age of 18 years the right to withhold information regarding previous criminal convictions, as well as cautions, warnings, reprimands and bind-overs, for any offence (not just those involving children) which for other purposes are spent under the provisions of the Act. You should disclose in this section any previous convictions, cautions, warnings, reprimands and bind-overs. Failure to disclose any previous convictions, cautions, warnings, reprimands or bind-overs could result in dismissal should it be subsequently discovered. Any information given, either when returning this application form or at interview will be entirely confidential and will be considered only in relation to this application. I confirm that I have no criminal convictions, cautions, warnings, reprimands or bind-overs, or are barred, disqualified from working with children. Signature: P.Rana

Print Name: Padmini Rana If you do have any criminal convictions, cautions, warnings, reprimands or bind-overs, or are barred, disqualified from working with children, please enclose full details in a sealed envelope marked Private and Confidential and tick this box. Having a criminal conviction will not necessarily bar you from employment.

16. RETURN ADDRESS

Please return to: For School Use Only: Please ensure that completed applications for successful candidates are returned via the new starter form on the Schools HR Portal.

 RECRUITMENT MONITORING
Name: Padmini Rana Job title: Clerical Assistant Job ref no if applicable: GENDER I am: xFemale Male Age: 35 Date of Birth: 08/11/1977

To help us monitor our Equal Opportunities in Employment Policy please tick or complete the following boxes as appropriate: ETHNIC ORIGIN Choose one section from (A) to (E) then tick the appropriate box to indicate your cultural background. These are based on the 2011 Census with additional categories included. A White British Irish Gypsy or Irish Traveller Albanian Any other White background, please indicate: B Mixed White/Black Caribbean White/Asian White/Black African Black/Asian Any other mixed background please indicate: C Asian or Asian British x Indian Kashmiri Pakistani Bangladeshi Chinese Any other Asian background, please indicate: D Black or Black British Caribbean African Any other Black background, please indicate: E Other ethnic group Arab Kurdish Vietnamese Any other please indicate: Not disclosed DISABILITY The Equality Act 2010 defines a person as having a disability if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day

to day activities. Do you have a disability as defined above? Yes: here. EMPLOYMENT STATUS Are you currently employed by Birmingham City Council? Are you currently employed by a school in Birmingham? Yes: Yes: No: x Nox No: x No: x If all of the above does not apply to you, however, you consider yourself to have a disability, please tick

If yes please state if you are employed on a temporary, casual or permanent basis: Are you currently unemployed? WHAT IS YOUR SEXUAL ORIENTATION? Bisexual RELIGION Lesbian or Gay x Heterosexual Not Disclosed Yes:

Christian (including Catholic, C of E, Protestant and all other Christian denominations) Buddhist No religion x Hindu Jewish Muslim Sikh Not stated Other - please specify:

JOB ADVERTISEMENT How did you first find out about this job? Please specify the source or publication. Schools Support Staff Bulletin WMJobs.co.uk Website, other (please specify) Birmingham Evening Mail Word of Mouth Search Consultant x Jobs4U Bulletin TES website Birmingham City Council Website TES printed press Radio (please specify) Jobcentre Plus

Professional Journal (please specify) Other printed media (please specify) Careers/open day (please specify) Other (please specify):