SUPPORTING STATEMENT

Please give details of any interests, responsibilities and experience which you consider relevant to your
application for this post. APPLICATION FORM

POST APPLIED FOR JOB REF:

THIS APPLICATION FORM CAN BE SUPPLIED IN LARGER PRINT, BRAILLE OR ON TAPE ON REQUEST

Thank you for requesting an application form for this vacancy. Please complete the application form as fully as possible
in BLACK INK. An attached c.v. will be welcome, but only as a supplement to the information on the application form.

PERSONAL DETAILS

SURNAME.............................................................. (Mr/Mrs/Miss/Ms) ADDRESS...............................................................................

FORENAME(S) .................................................................................... ........................................................................................................

................................................................................................................. ........................................................................................................

TEL NO (HOME).................................................................................. POST CODE..................................................

TEL NO (WORK).................................................................................. May we contact you at work? YES/NO

(Please attach a separate sheet if necessary)
PREVIOUS SURNAME ...................................................................... email address............................................................................
REFEREES
Please give details of two people who are able and willing to comment on your suitability for this job. PLACE OF BIRTH National Insurance No.
If you are, or have been employed, one should be your present or most recent employer.
Do you have the right to work in the UK? Yes/No
CURRENT OR LAST EMPLOYER PREVIOUS EMPLOYER
HEALTH – Number of days of sickness in last 12 months
Name…………………………………………. Name………………………………………….
If you are offered a post with Worcester College of Technology it will be subject to a medical check.
Address ………………………………………. Address ………………………………………. Are you related to or do you have a close personal friendship with any staff member of the College?
If yes, please state relationship.
………………………………………………… …………………………………………………

………………………………………………… …………………………………………………

E-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How did you find out about this post?………………………………………………….…………………
Tel. No. ………………………………………. Tel. No. ……………………………………….
If appointed, the information provided on this form will be held in your manual and computerised personal records
Relationship to you, e.g. Manager Relationship to you, e.g. Manager and will be used by College agents to support pension and payroll provisions and contacting you or next-of-kin. The
College also retains information provided by all applicants relating to ethnic origin, age, disability and gender for the
References are normally taken up prior to interview. References are normally taken up prior to interview. purpose of equal opportunities monitoring.
May we contact this referee prior to interview May we contact this referee prior to interview
YES NO YES NO
Worcester College of Technology is registered under the DPA 1998. This information will not be used for any other
I declare that the information given in this application is correct and complete and understand that all appointments purpose. You have a right of access to your information under Data Protection legislation.
are subject to satisfactory Enhanced Criminal Records Bureau Disclosure.
This application form should be returned to: The Human Resources Advisor
Signed ……………………………………………………………… Date ……………………………… no later than the closing date. Worcester College of Technology
Deansway
You may be disqualified if you have made false statements or failed to disclose any information which has Worcester
been requested on this form. If this is discovered after you have been appointed, it may lead to dismissal WR1 2JF
or disciplinary action. Please enclose a stamped-addressed envelope if acknowledgement of receipt of this form is required. Letters will
Admin 0019(A) June 07
otherwise only be sent to shortlisted applicants.
EDUCATION, TRAINING AND QUALIFICATIONS
Name of School/College/University Dates Attended Qualifications* including Dates Obtained PREVIOUS EMPLOYMENT (most recent first)
Attended Grades/Class/Div. Etc.

Qualifications Employer Position Held Brief Description of Duties/Responsibilities Reason for Leaving Dates
(including Professional and Teaching)
From: To:

Further or Higher Education

(Full and Part Time)

Professional Development or other relevant

training
(including most recent training courses attended)

Highest numeracy and literacy

qualification. (Mathematics and English)

PRESENT EMPLOYMENT
Post Name & Address of Employer

Duties/Responsibilities

Date Appointed

Salary and/or Grade

Reason for leaving or planning to leave Period of Notice

Do you have Qualified Teacher Status? Yes/No Please state qualification

e.g. PGCE, Cert Ed, B.Ed, TQFE

Current Membership of Professional Please give details

Organisations*
Do you possess a full current UK Driving Licence? Yes/No
Do you contribute to:
Teachers Pension Scheme Yes/No
Local Government Pension Scheme Yes/No
* If you are invited for interview we will ask you to produce documentary evidence of your stated qualifications/professional membership(s).
EDUCATION, TRAINING AND QUALIFICATIONS
Name of School/College/University Dates Attended Qualifications* including Dates Obtained PREVIOUS EMPLOYMENT (most recent first)
Attended Grades/Class/Div. Etc.

Qualifications Employer Position Held Brief Description of Duties/Responsibilities Reason for Leaving Dates
(including Professional and Teaching)
From: To:

Further or Higher Education

(Full and Part Time)

Professional Development or other relevant

training
(including most recent training courses attended)

Highest numeracy and literacy

qualification. (Mathematics and English)

PRESENT EMPLOYMENT
Post Name & Address of Employer

Duties/Responsibilities

Date Appointed

Salary and/or Grade

Reason for leaving or planning to leave Period of Notice

Do you have Qualified Teacher Status? Yes/No Please state qualification

e.g. PGCE, Cert Ed, B.Ed, TQFE

Current Membership of Professional Please give details

Organisations*
Do you possess a full current UK Driving Licence? Yes/No
Do you contribute to:
Teachers Pension Scheme Yes/No
Local Government Pension Scheme Yes/No
* If you are invited for interview we will ask you to produce documentary evidence of your stated qualifications/professional membership(s).
SUPPORTING STATEMENT
Please give details of any interests, responsibilities and experience which you consider relevant to your
application for this post. APPLICATION FORM

POST APPLIED FOR JOB REF:

THIS APPLICATION FORM CAN BE SUPPLIED IN LARGER PRINT, BRAILLE OR ON TAPE ON REQUEST

Thank you for requesting an application form for this vacancy. Please complete the application form as fully as possible
in BLACK INK. An attached c.v. will be welcome, but only as a supplement to the information on the application form.

PERSONAL DETAILS

SURNAME.............................................................. (Mr/Mrs/Miss/Ms) ADDRESS...............................................................................

FORENAME(S) .................................................................................... ........................................................................................................

................................................................................................................. ........................................................................................................

TEL NO (HOME).................................................................................. POST CODE..................................................

TEL NO (WORK).................................................................................. May we contact you at work? YES/NO

(Please attach a separate sheet if necessary)
PREVIOUS SURNAME ...................................................................... email address............................................................................
REFEREES
Please give details of two people who are able and willing to comment on your suitability for this job. PLACE OF BIRTH National Insurance No.
If you are, or have been employed, one should be your present or most recent employer.
Do you have the right to work in the UK? Yes/No
CURRENT OR LAST EMPLOYER PREVIOUS EMPLOYER
HEALTH – Number of days of sickness in last 12 months
Name…………………………………………. Name………………………………………….
If you are offered a post with Worcester College of Technology it will be subject to a medical check.
Address ………………………………………. Address ………………………………………. Are you related to or do you have a close personal friendship with any staff member of the College?
If yes, please state relationship.
………………………………………………… …………………………………………………

………………………………………………… …………………………………………………

E-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How did you find out about this post?………………………………………………….…………………
Tel. No. ………………………………………. Tel. No. ……………………………………….
If appointed, the information provided on this form will be held in your manual and computerised personal records
Relationship to you, e.g. Manager Relationship to you, e.g. Manager and will be used by College agents to support pension and payroll provisions and contacting you or next-of-kin. The
College also retains information provided by all applicants relating to ethnic origin, age, disability and gender for the
References are normally taken up prior to interview. References are normally taken up prior to interview. purpose of equal opportunities monitoring.
May we contact this referee prior to interview May we contact this referee prior to interview
YES NO YES NO
Worcester College of Technology is registered under the DPA 1998. This information will not be used for any other
I declare that the information given in this application is correct and complete and understand that all appointments purpose. You have a right of access to your information under Data Protection legislation.
are subject to satisfactory Enhanced Criminal Records Bureau Disclosure.
This application form should be returned to: The Human Resources Advisor
Signed ……………………………………………………………… Date ……………………………… no later than the closing date. Worcester College of Technology
Deansway
You may be disqualified if you have made false statements or failed to disclose any information which has Worcester
been requested on this form. If this is discovered after you have been appointed, it may lead to dismissal WR1 2JF
or disciplinary action. Please enclose a stamped-addressed envelope if acknowledgement of receipt of this form is required. Letters will
Admin 0019(A) June 07
otherwise only be sent to shortlisted applicants.
CONFIDENTIAL

This sheet will be separated from the accompanying application form immediately on receipt and before any
consideration of candidates occurs.

POST APPLIED FOR …………………………………………..

SURNAME ………………………………………. FORENAME(S) .............................................................

EQUAL OPPORTUNITIES
The following information will be completely confidential and used for monitoring purposes only.
Please be assured that this information is not required as part of the selection process and will not be made available to those
persons assessing candidates and making appointments.

Ethnicity: (please tick only one) Chinese

Asian or Asian British - Bangladeshi Mixed - White and Asian
Asian or Asian British - Indian Mixed - White and Black Caribbean
Asian or Asian British - Pakistani Mixed - any other background
Asian or Asian British - any other background White - British
Black or Black British - African White - Irish
Black or Black British - Caribbean White - any other background
Black or Black British - any other background Any other

WHAT SEX ARE YOU? MALE/FEMALE DATE OF BIRTH AGE……YEARS

DISABILITY

We undertake to interview disabled people who meet the essential criteria detailed on the person specification. For these pur-
poses, disability is defined as a physical or mental impairment which has a substantial and long term (over 12 months) adverse
effect on your ability to carry out normal day-to-day activities. If you become an employee, the College will have a duty towards
you under the Disabilty Discrimination Act and Health & Safety legislation. Although your disabled status will be kept
confidential, your Head of Department or Line Manager will be made aware of this so that they can arrange for any risk
assessment or workplace support that might be necessary.

Do you consider yourself to be disabled? Yes No

If you are disabled, please tell us if you need any particular arrangements to be made for interview e.g. car parking space.
Please give brief details of how we may help you if you are appointed.

CONVICTIONS OR DISQUALIFICATIONS
Applicants for this post in the College are reminded that it is exempt from the provisions of the Rehabilitation of Offenders Act
1974 and they are therefore required to provide information about any convictions (including ‘Spent Convictions’) cautions or bind
overs. In the event of employment, you will be required to apply for Disclosure via the Criminal Records Bureau. Failure to disclose
any convictions could result in dismissal or disciplinary action by the corporation. A criminal record will not necessarily be a bar
to appointment. Any information given will be completely confidential and will be considered only in relation to the application
for this post. If this is applicable to you, would you please indicate below any convictions you may have.

I declare that I am not on list 99, disqualified from working with children or vulnerable adults, or subject to sanctions
imposed by a regulatory body, e.g the General Teaching Council, and confirm that the information given is correct
and complete.

Signed ...................................................................... Date .............................................

Admin 0019(B) July 07