CONFIDENTIAL SWOne App EXT v7_0412

Southwest One Application Form - External

Before comple!n"# ple$%e en%&re 'o& ($ve re$) (e *o+ De%cr!p!on $n) ,er%on Spec!f!c$!on-
Please return this form to Recruitment Team, County Hall, Taunton TA !"#
Email recruitment$somerset%&o'%u(
Appl!c$!on for (e po% of Application Support En&ineer )e'el
*o+ .eference N&m+er *!+,A-.
Clo%!n" D$e / -ay */!
Part A0 Personal "etails 1.loc( capitals please2
F$m!l' N$me / S&rn$me C$rer
,rev!o&% N$me0%1
Foren$me0%1 D$v!) *o(n
2no3n N$me4
0If )!fferen from Foren$me1

,referre) T!le
0E"- 5r# 5r%# 5!%%# 5%# Dr1
5.
C&rren A))re%%
0,le$%e !ncl&)e ,o%co)e1
14 mon6%one Dr!ve Berro3 Somer%e TA7 2NW
N$!on$l In%&r$nce N&m+er *N441894C
,referre) Con$c Telep(one
N&m+er
01277 771748
Alern$!ve Telep(one N&m+er
0If $v$!l$+le1
07791109:82
Em$!l A))re%%
0If preferre) me(o) of
comm&n!c$!on ; !n re"&l$r &%e1
c$r)0:07<(om$!l-com
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CONFIDENTIAL SWOne App EXT v7_0412
Part .0 Present Post
N$me $n) A))re%%
of Emplo'er
Op!on% .e%o&rc!n" :0 >&een
S?&$re# Br!%ol# C!' of Br!%ol BS1
4ND
Are 'o& c&rrenl' emplo'e) +' $n
A"enc' @e% No
If 'e%# ple$%e "!ve (e n$me of (e
A"enc' Options Resourcing
*o+ T!le CSCS %!e Lo&+o&rer
S$r D$e 27/11/1: No!ce re?&!re) none
S$l$r' 7-A per (o&r If p$r=!me#
ple$%e "!ve
(o&r% per 3ee6

I% 'o&r c&rren po% $
f!Be) erm conr$cC
No @e% 0!f 'e%# ple$%e "!ve en) of conr$c )$e1
,le$%e "!ve )e$!l% of 'o&r m$!n $%6% $n) re%pon%!+!l!!e%

,le$%e eBpl$!n 3(' 'o& $re $ppl'!n" for (!% po% $ (!% !me4

Part C0 Pre'ious Employment 1most recent first2
,le$%e "!ve $% m&c( relev$n !nform$!on $% po%%!+le-
N$me ; A))re%% of
Emplo'er
D$e% From/To
055/@@1
*o+ .ole F!n$l S$l$r' $n)
.e$%on for Le$v!n"

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CONFIDENTIAL SWOne App EXT v7_0412
Part "0 Aca3emic, Professional an3 4ocational 5ualifications
EB$m% ,$%%e) 0Level1
>&$l!f!c$!on% ; 5em+er%(!p%
05o% .ecen F!r%1
Dr$)e $n)
D$e
Ac(!eve)E
N$me of E)&c$!on$l E%$+l!%(men $n)/or
,rofe%%!on$l or A3$r)!n" Bo)'

6For po%% 3or6!n" 3!( c(!l)ren/v&lner$+le $)&l% 'o& m&% prov!)e $ll )$e%-
Part E0 Trainin&,Continuin& Professional "e'elopment
,le$%e "!ve )e$!l% of relev$n r$!n!n"/)evelopmen $c!v!!e%-
Tr$!n!n" Co&r%e $n) Or"$n!%er
or Developmen Ac!v!'
T!me %pen O&come = Dr$)e Ac(!eve)
0W(ere $ppl!c$+le1

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CONFIDENTIAL SWOne App EXT v7_0412
Part F0 Personal Statement
@o& m$' con!n&e on $ %ep$r$e %(ee !f 'o& nee) o-
7ey Competencies, 7nowle3&e an3 S(ills4 .eferr!n" o (e per%on %pec!f!c$!on# prov!)e
eB$mple% of (o3 'o& ($ve )emon%r$e) (e 6e' compeenc!e% $n) (e 6no3le)"e $n) %6!ll
re?&!remen% for (!% role- @o& m$' &%e eBper!ence "$!ne) from 3!(!n $n)/or o&%!)e (e
3or6pl$ce o prov!)e (e%e eB$mple%- 0We recommen) ($ 'o& &%e (e )!fferen (e$)!n"% on
(e per%on %pec!f!c$!on $% $ %$r!n" po!n-1

Personal Attri8utes0 ,le$%e )e%cr!+e 3$'% !n 3(!c( 'o& ($ve )emon%r$e) (e per%on$l
$r!+&e% re?&!re) for (!% po%# $% o&l!ne) !n (e per%on %pec!f!c$!on-

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CONFIDENTIAL SWOne App EXT v7_0412
Part 90 Supplementary :nformation
Personal Transport0 For po%% 3(!c( !nvolve r$vel $3$' from norm$l pl$ce of 3or64
Are 'o& 3!ll!n" $n) $+le o r$vel o mee (e re?&!remen% of (e po%C @e% No
,le$%e prov!)e )e$!l% of $n' c&rren moor!n" conv!c!on%# )!%?&$l!f!c$!on% or pen$l' po!n%#
3!( )$e% $n) re$%on% $n)/or $n' )!ff!c&l!e% 'o& fore%ee concern!n" r$vel4

Positi'e A8out "isa8ility0 We 3elcome $ppl!c$!on% from people 3!( )!%$+!l!!e%- W(erever
po%%!+le 3e 3!ll m$6e re$%on$+le $)F&%men% o en$+le $ per%on 3!( $ )!%$+!l!' o $cce%% (e
$ppl!c$!on $n) $ppo!nmen proce%% f$!rl'-
Do 'o& con%!)er 'o&r%elf o ($ve $ )!%$+!l!'C @e% No
If G'e%H $n) 'o& $re offere) $n !nerv!e3# 3o&l) 'o& 3elcome $ pre=
!nerv!e3 )!%c&%%!on o !)en!f' $n' p$r!c&l$r nee)% ($ 'o& m$' ($veC
@e% No
"isclosure of Criminal Offences0 T(e .e($+!l!$!on of Offen)er% Ac 1874 "!ve% !n)!v!)&$l%
(e r!"( no o )!%clo%e )e$!l% of ol) offence% 3(!c( $re %een $% I%penJ
,le$%e "!ve )e$!l%# !ncl&)!n" )$e% $n) pl$ce%# of pen)!n" pro%ec&!on% $n) $n' conv!c!on%#
c$&!on% $n) +!n)=over% %!nce (e $"e of 17 'e$r%# ($ $re no I%penJ4

"ATA PROTECT:O; ACT <<=% Inform$!on from (!% $ppl!c$!on m$' +e proce%%e) for $n'
p&rpo%e% re"!%ere) +' So&(3e% One L) &n)er )$$ proec!on le"!%l$!on- T(e !nform$!on
($ 'o& %&ppl' !n 'o&r $ppl!c$!on !% conf!)en!$lK (o3ever# ! 3!ll +e )!%clo%e) o (o%e per%on%
$&(or!%e) o %ee ! $n) o +e &%e) for %elec!on p&rpo%e%- T(e !nform$!on from %&cce%%f&l
c$n)!)$e% 3!ll +e re$!ne) on (e per%onnel f!le for p$'roll $n) $)m!n!%r$!ve p&rpo%e%K
!nform$!on (el) $+o& &n%&cce%%f&l $ppl!c$n% !% )e%ro'e) $fer one 'e$r- T(!% !nform$!on
m$' +e )!%clo%e) o Dovernmen Dep$rmen% 3(ere (ere !% $ le"$l o+l!"$!on o )o %o- All
!n)!v!)&$l% ($ve (e r!"( o $cce%% (e!r o3n per%on$l )$$ (el) +' So&(3e% One L)-
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CONFIDENTIAL SWOne App EXT v7_0412
PART H0 REFERE;CES A;" "EC)ARAT:O;S
References0 ,le$%e prov!)e (e n$me% of 3o profe%%!on$l referee%# +o( of 3(om c$n 3r!e
3!( $&(or!' $+o& 'o&r perform$nce# $+!l!!e% $n) compeence !n $ 3or6# vol&n$r' or
e)&c$!on$l env!ronmen- T(e f!r% reference m&% +e 'o&r m$n$"er or $ %en!or m$n$"er
repre%en!n" 'o&r c&rren or mo% recen role- .eference% 3!ll no +e $ccepe) from colle$"&e%#
rel$!on% or people 3(o 6no3 'o& %olel' $% $ fr!en)- If 'o& )o no 3$n 'o&r c&rren emplo'er o
+e con$ce) pr!or o !nerv!e3 ple$%e !c6 (e +oB +elo3-
;ame of first referee
*o+ T!le of .eferee
N$me of or"$n!%$!on
A))re%% 0Incl&)!n" ,o%co)e1
Em$!l $))re%% !f $v$!l$+le
D$'!me elep(one n&m+er
.el$!on%(!p o 'o& 0e" %&perv!%or#
&or1

D$e% of 'o&r emplo'men From4 / To4 /
;ame of secon3 referee
*o+ T!le of .eferee
N$me of or"$n!%$!on
A))re%% 0Incl&)!n" ,o%co)e1

Em$!l $))re%% !f $v$!l$+le

D$'!me elep(one n&m+er

.el$!on%(!p o 'o&

D$e% of 'o&r emplo'men
From4 / To4 /
"eclaration
I conf!rm ($ I $m en!le) o l!ve $n) 3or6 !n (e Ln!e) 2!n")om-
I $m 3!ll!n" for (!% )$$ o +e (el) $n) proce%%e) +' So&(3e% One L!m!e) $n) o +e
ver!f!e) 3!( relev$n (!r) p$r!e%- T(!% m$' !ncl&)e prev!o&% emplo'er%-
T(e !nform$!on on (!% form !% $cc&r$e- I &n)er%$n) ($ prov!)!n" f$l%e !nform$!on !% $n
offence $n) m$' le$) o m' $ppl!c$!on +e!n" )!%$llo3e) or# %(o&l) I +e $ppo!ne)# o m'
)!%m!%%$l $n)# 3(ere $ppropr!$e# m$' +e referre) o (e pol!ce-
S!"ne) D$e
If 'o& %&+m! (!% $ppl!c$!on elecron!c$ll' $n) $re %(orl!%e)# 'o& 3!ll +e $%6e) o %!"n 'o&r
$ppl!c$!on $ !nerv!e3-
So&( We% One L!m!e) = .e"!%ere) !n En"l$n) $n) W$le% 3!( n&m+er 9:7 770
.e"!%ere) off!ce4 ,O BoB 41# Nor( M$r+o&r# ,or%mo&(# M$n% ,O9 :AL
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CONFIDENTIAL SWOne App EXT v7_0412
Confi3ential
E>ual Opportunities-Recruitment -onitorin&
This form will 8e (ept separate from your application form% :t is not referre3 to 3urin& the
selection process%
We v$l&e )!ver%!' $n) $re comm!e) o promo!n" e?&$l!' of oppor&n!' for o&r emplo'ee% $n)
Fo+ $ppl!c$n%-
We mon!or o&r recr&!men $n) %elec!on pr$c!ce% o f&lf!l o&r %$&or' )&' relev$n o e?&$l!'
!n emplo'men $n) o en%&re o&r pr$c!ce% $re f$!r# e?&!$+le $n) con%!%en 3!( (e $!m of
$ppo!n!n" (e +e% per%on for (e Fo+- .ecr&!men mon!or!n" en$+le% &% o $6e $c!ve %ep% o
promoe +eer pol!c' $n) or"$n!%$!on$l pr$c!ce-
T(e !nform$!on 'o& %&ppl' on (!% ?&e%!onn$!re 3!ll +e recor)e) conf!)en!$ll' on o&r M.
S'%em% $n) (el) for $ m$B!m&m of 12 mon(%- D&r!n" (!% !me ! 3!ll +e &%e) %olel' for (e
p&rpo%e% of mon!or!n" (e prof!le of o&r Fo+ $ppl!c$n%- Acce%% o (e )$$ 3!ll +e re%r!ce) o
nom!n$e) %$ff 3!(!n (e M. Serv!ce-
If 'o& $re $ppo!ne)# (e )$$ 3!ll $l%o +e &%e) for o&r M./,$'roll recor)% p&rpo%e%# 3(!c(
!ncl&)e% $no(er le"$l re?&!remen# 3or6force mon!or!n"- We $!m o en%&re $ll $ppl!c$n% $n)
emplo'ee%# re"$r)le%% of c!rc&m%$nce% or %$&%# rece!ve e?&$l $cce%% o oppor&n!' $n) f$!r
re$men-
For (e%e re$%on% ! !% !mpor$n ($ 'o& complee (e recr&!men mon!or!n" ?&e%!onn$!re !n
$))!!on o (e $ppl!c$!on form- Once complee)# (e ?&e%!onn$!re %(o&l) +e re&rne) 3!( 'o&r
$ppl!c$!on o (e .ecr&!men A)m!n!%r$or# (e $))re%% of 3(!c( !% )e$!le) !n (e .ecr&!men
Inform$!on ,$c6-
T($n6 'o& for 'o&r co=oper$!on-
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SWOne App EXT v7_0412
E5?A) OPPORT?;:T:ES @ RECR?:T-E;T -O;:TOR:;9
T(!% !nform$!on 3!ll +e re$e) !n (e %r!ce% conf!)ence
Post Applie3 for Appl!c$!on S&ppor En"!neer
Level 1
Reference ;o4 124:/A5B
;ame D$v!) c$rer Ahat is your 3ate of 8irthB /+,/C,<=D
Are youB
,le$%e !c6 one of (e $ppropr!$e +oBe% $"$!n% e$c( (e ?&e%!on% +elo3
9en3er
1- Fem$le 2- 5$le :- ,refer no o %$'
Sexual Orientation
1- B!%eB&$l 2- D$' /Le%+!$n :- Meero%eB&$l 4- ,refer no o %$'
Trans&en3er
1- @e% 2- No :- ,refer no o %$'
How woul3 you 3escri8e your ethnic ori&inB
a2 Ahite N- En"l!%(/Wel%(/Sco!%(/Nor(
Ir!%(/Br!!%(
2- D'p%' or Ir!%( Tr$veller
D- Ir!%( >- An' o(er W(!e B$c6"ro&n)
82 -ixe3,-ultiple
Ethnic
M- W(!e $n) Bl$c6 C$r!++e$n I- W(!e $n) Bl$c6 Afr!c$n
*- W(!e $n) A%!$n S- An' o(er m!Be) +$c6"ro&n)
c2 Asian or
Asian .ritish
E- In)!$n X- ,$6!%$n! D- B$n"l$)e%(!
,- C(!ne%e @- An' o(er A%!$n +$c6"ro&n)
32
.lac(,African
,Cari88ean,
.lac( .ritish
T- C$r!++e$n O- Afr!c$n .- An' o(er +l$c6
+$c6"ro&n)
e2 Other ethnic
&roup
A- Ar$+ B- An' o(er "ro&p
f2 Prefer not to say
"o you consi3er yourself to ha'e a 3isa8ility or impairmentB
Ln)er (e E?&$l!!e% Ac 2010# $ per%on 3!( $ )!%$+!l!' !% )ef!ne) $% ($v!n" $ p('%!c$l or men$l
!mp$!rmen 3(!c( ($% $ %&+%$n!$l# lon" erm effec on (e!r $+!l!' o c$rr' o& norm$l )$' o )$'
$c!v!!e%-
@e% No
If 'e%# ple$%e !n)!c$e (e n$&re of 'o&r )!%$+!l!'-
,('%!c$l Imp$!rmen 5en$l Imp$!rmen 5o+!l!' Imp$!rmen
O!%&$l Imp$!rmen Me$r!n" Imp$!rmen Le$rn!n" D!%$+!l!'
5ore ($n one
Imp$!rmen
O(er
Ahich Reli&ious 9roup 3o you 8elon& toB
0 B&))(!% C(r!%!$n * M!n)& + *e3!%( ! 5&%l!m
= S!6( A No D An' o(er C ,refer no
7
SWOne App EXT v7_0412
.el!"!on rel!"!on o %$'
Are you currently employe3 8y Southwest OneB
@e% No
If 'e%# ple$%e $n%3er (e ?&e%!on% +elo3 !n re%pec of 'o&r main conr$c-
If So&(3e% One )oe% no c&rrenl' emplo' 'o&# (ere $re no f&r(er ?&e%!on% for 'o& o complee-
:s your main contractB
,erm$nen F!Be) Term C$%&$l / .el!ef
Ahich Ser'ice Area 3o you currently wor( inB

:s the position you are applyin& for a promotion , &ra3e increase
@e% No
Than( you for your cooperation%
Please return the complete3 >uestionnaire with your application form%
8