APPLICANT MONITORING QUESTIONNAIRE€¦  · Web viewThe Council intends to provide equal opportunities for everyone regardless of age, disability, ethnicity, gender (including gender

APPLICANT MONITORING QUESTIONNAIRE

Confidential

Please refer to the Application Form Guidance Notes prior to completing this form.Please complete the form using BLACK INK.

FOR OFFICE USE ONLY

Entered on system

Applicant No.

Vacancy Details

Post Applied for:       Directorate:      

Section 1

Personal DetailsTitle       Forenames:       Surname      

Address:     

Post Code:     

Telephone (home):     

Telephone (work):      

Mobile:      

Email:      

National Insurance No.       Date of Birth:      

ReferencesPlease give details of two people (not relatives) who will act as referees, one of these should be your present or last employer (if any):

NAME:     

POSITION:      

ADDRESS:      

POST CODE     

TEL:      

Email address:      

Please indicate if this referee may be contactedbefore interview YES NO

NAME:      

POSITION:      

ADDRESS:      

POST CODE     

TEL:      

Email address:      

Please indicate if this referee may be contactedbefore interview YES NO

Advertising Media MonitoringWhere did you see this vacancy advertised?

Newspaper (Please specify)       Job CentreProfessional Journal (Please specify)       Internal

Other (Please specify)       Internet

The Council intends to provide equal opportunities for everyone regardless of age, disability, ethnicity, gender (including gender reassignment), religion/belief or sexual orientation. Please complete the following sections in order to help us monitor our Equal Opportunities Policy. The form will be kept separate from your application form and will not be available to those short listing. Please tick the appropriate boxes.

DisabilityApplications from candidates with disabilities are welcomed by the Council. The Council’s policy is that if you are disabled you are guaranteed an interview under the Interview Guarantee Scheme as long as you satisfy the essential criteria for the job.

The Equality Act 2010, defines disability as ‘a physical or mental impairment which has a substantial and long-term effect on the ability to carry out normal day to day activities’.

Do you consider that you have a disability? No Yes

If yes, please give brief details:      

Do you need any reasonable adjustments to help you participate in the interview or tests associated with it?

No Yes If yes, please give brief details:     

Age

16-24 25-34 35-44 45-54 55-64 65+

Ethnic GroupWould you describe your ethnic origin as: (These are based on the census 2001 categories and are listed alphabetically)

Asian: Bangladeshi Black: African Mixed: White & Asian White: English

Asian: Indian Black: Caribbean Mixed: White & Black African White: Irish

Asian: Pakistani Black: Other Mixed: White & Black Caribbean White: ScottishAsian: Other(please state) Chinese Mixed: White & Chinese White: Welsh

Mixed: Other Mixed(please state)

White: Other(please state)

Gender

Are you: Male Female Prefer not to say

Have you ever identified as transgender? Yes No Prefer not to say

Applicant No..

Religious BeliefWhich group below do you most identify with?

No Religion Baha’i Buddhist Other (please specify)

Christian Hindu Jain

Jewish Muslim Sikh

Sexual OrientationWhat is your sexual orientation?

Bisexual Gay Man Lesbian Heterosexual Other (please specify)      

Rehabilitation of OffendersUnder the Rehabilitation of Offenders Act 1974, you are required to give details of any criminal convictions which are ‘not spent’. Having a relevant conviction does not automatically bar you from employment.

Do you have unspent criminal convictions or are you at present the subject of criminal charges?

Yes No If yes, please give details (excluding spent convictions)     

CanvassingAre you, to the best of your knowledge related to any Councillor or Officer of Wyre Council?

Yes No If yes, please state name and position:     

Please note: Canvassing of elected members of Wyre Council and/or employees will disqualify you from employment with the Council.

DeclarationI declare that the information I have given on this form and also on the Application for Employment form is correct and understand that if appointed, I will be liable to disciplinary action including dismissal and/or criminal action should I knowingly give false information.

I give my permission for this personal information to be stored and processed for the purposes of arriving at an selection decision and for sensitive data to be monitored for the purpose of equal opportunities monitoring. I also give permission for the information provided to be used to form the basis of personnel records should I be appointed.

Signature Date

Wyre Council must protect the public funds it handles and so we may 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. Only the information from the forms of successful candidates will be used for this purpose.

APPLICATION FOR EMPLOYMENT

Vacancy DetailsPost applied for:       FOR OFFICE USE ONLY

Directorate Date Ack:

Applicant no.

Section 2: Present Employment (or most recent employment)

Name and address of Employer: Date appointed:            Salary:      

Postcode Notice Required:      Position     

Leaving Date      (if applicable):

Reason for Leaving      

Brief Outline of Duties and Responsibilities:     

Section 3: Details of Previous Employment(Please start with most recent employment.) Please also account for any gaps in your employment history.

Name & Address of Employer Post held & main duties Period Reason for From To Leaving

Driving LicenceDo you hold a current driving licence? Yes No Do you hold a current LGV

licence? Yes No

Section 4: Qualifications (You will be required to provide proof of qualifications at interview)Give details of all qualifications, including GCE, CSE, GCSE, A Level, Degree, Professional & Vocational Qualifications.

Qualification Year of examination/assessment Results with grades

Membership of Professional/Technical Associations:(Please indicate whether membership follows final examination)     

Computer Software Experience/Qualifications:(If a requirement on the Person Specification)     

Section 5: Training (Please list courses attended which are relevant to this post)

Training Course Organising Body Dates                 

Section 6: CompetenciesFor this section please refer to the specific competencies identified in the Person Specification for the post you are applying for.

For each of these provide examples of how you have displayed the behaviour in the past. Please note that examples can be from your professional and/or personal life.

Here to Help     

Innovative     

Efficient and Businesslike     

Pride in our Council     

Open and Honest     

One Team One Council     

Section 6 (continued): Experience

Referring to the person specification (Use additional A4 sheets if needed), please indicate how you meet the essential and desirable skills, knowledge/abilities and experience requirements and any other criteria for this post. Please also use this section to state the reasons why you wish to apply for this post.     

Section 7: Related ActivitiesPlease indicate any activities, paid or unpaid, which you consider indicate your suitability for the post.     

Any dates not available for interview?     

COMPLETED FORMS SHOULD BE RETURNED TO: [email protected] or Human Resources Section

Wyre CouncilCivic CentreBreck Road Poulton-le-FyldeLancashire FY6 7PU