Application Form – Support Staff

Name of Applicant:

Position applied for:

The School is legally required to carry out a number of pre-appointment checks which are detailed
in the School's Recruitment, selection and disclosure policy and procedure. The information you
are being asked to provide in this form is required so that the School can comply with those legal
obligations should your application be successful.
Section 1: Personal details

National Insurance
Title: Dr/Mr/Mrs/Miss/Ms/Other
Number:

Forenames: Surname:

Known as / Preferred name: Former Name(s):

Address:
Contact details:
Home:
Mobile:

Email address:

Please note to use the check boxes below, double click on the box and select either ‘checked’ or ‘not checked’

Are you eligible for employment in the UK? Yes No

Please provide details: (UK Passport, UK Birth Certificate, Visa,

Work Permit)

Have you read the School's Child Protection Policy? Yes No

Section 2: Sanctions, restrictions and prohibitions

Have you ever been referred to the Department for Education, Yes No
or are you the subject of a direction under section 128 of the
Education and Skills Act 2008 which prohibits, disqualifies or
restricts you from being involved in the management of an
independent school?

Have you ever been the subject of a direction under section Yes No
142 of the Education Act 2002?
If answering "Yes" to any of the questions in Section 2 please provide details on a separate sheet and send this in a
sealed envelope marked "confidential" with your application form.

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Section 3: Education (Please start with most recent)

Name of Dates of Examinations

University/College/School Attendance
Subject Result Date Awarding
dd/mm/yy
Body
From To

From To

From To

From To

From To

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Section 4: Other vocational qualifications, skills or training

Please provide details of any vocational qualifications or skills that you possess or training that you have received
which you consider to be relevant to the role for which you have applied.

Section 5: Current or Most Recent Employment

Current or most recent employer:

Current or most recent employer's address:

Current or most recent job title:

Date started: Date employment ended Current salary / salary on leaving:

(if applicable):

Do you / did you receive any employee benefits? Yes No

If so, please provide details of these:

Reason for seeking other employment:

Please state when you would be available to take up

employment if offered / length of notice period:

Section 6: Previous Employment and / or activities since leaving secondary education

Please continue on a separate sheet if necessary

DD/MM/YY Name and address Position held and / or duties Reason for leaving
of employer

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From To

From To

From To

From To

From To

From To

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Section 7: Gaps in your employment
If there are any gaps in your employment history, e.g., looking after children, sabbatical year, travelling, looking for
work, please give details and dates

Section 8: Interests
Please give details of your interests, hobbies or skills - in particular any which could be of benefit to the School for
the purposes of enriching its co-curricular activities

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Section 9: Suitability
Please give your reasons for applying for this post and say why you believe you are suitable for the position. Study
the job description and person specification and describe any experience and skills you have gained in other jobs or
similar environments which demonstrate your ability and aptitude to undertake the duties of the post. Continue on
a separate sheet if necessary.

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Section 10: Criminal record

The School applies for an Enhanced Disclosure from the Disclosure and Barring Service (DBS), including a Children's
Barred List check for all positions at the School which amount to regulated activity. It is unlawful for the School to
employ anyone who is barred from working with children. It is a criminal offence for any person who is barred from
working with children to attempt to apply for a position at the School. If you are successful in your application you
will be required to complete an Enhanced DBS Disclosure application form. Employment with the School is
conditional upon the School being satisfied with the result of the Enhanced DBS Disclosure. Any information
disclosed will be handled in accordance with any guidance and / or code of practice published by the DBS.

The School is exempt from the Rehabilitation of Offenders Act 1974 and is therefore permitted to ask job
applicants to declare all convictions, cautions, reprimands and final warnings (including those which would
normally be considered "spent") in order to assess their suitability to work with children.

The amendments to the Rehabilitation of offenders Act 1974 [exceptions] Order 1975 [2013 and 2020] provides
that when applying for certain jobs and activities, certain convictions and cautions are considered protected.

You are not required to disclose a caution or conviction for an offence committed in the United Kingdom if it has
been filtered in accordance with the DBS filtering rules (see Appendix 1 to this form).

If you have a criminal record this will not automatically debar you from employment. Instead, each case will be
assessed fairly by reference to the School's objective assessment procedure set out in the School's recruitment,
selection and disclosure policy and procedure.

It is a condition of your application that you answer the questions below. Before doing so, please read Appendix 1.

Have you been cautioned, subject to a court order, bound over, received a Yes No
reprimand or warning or been found guilty of committing any criminal
offence whether in the United Kingdom or in another country? You are not
required to disclose a caution or conviction for an offence committed in the
United Kingdom which is subject to the DBS filtering rules (see Appendix 1).

Is there any relevant court action pending against you? Yes No

Do you have any unspent conditional cautions or convictions under the Yes No
Rehabilitation of Offenders Act 1974?

Do you have any adult cautions (simple or conditional) or spent convictions Yes No
that are not protected as defined by the Rehabilitation of Offenders Act 1974
[exceptions] Order 1975 [amendment] [England and Wales] Order 2020?

If answering "YES" to any of the above, please provide details on a separate sheet and send this in a sealed
envelope marked "confidential" with your application form.

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Section 11: References
Please supply the names and contact details of two people who we may contact for references. One of these must
be your current or most recent employer. If your current / most recent employment does / did not involve work
with children, then your second referee should be from your employer with whom you most recently worked with
children. Neither referee should be a relative or someone known to you solely as a friend. The School intends to
take up references on all shortlisted candidates before interview. The School reserves the right to take up
references from any previous employer. Should your most recent employer be an educational establishment, a
satisfactory reference should be completed and signed by the Headmaster, Headmistress or equivalent, as the
contract may be withheld until this is received.
As part of the referencing process, the School will undertake a digital screening, including online searches of
candidates and any potential matters of concern will be discussed with the candidate.
If the School receives a factual reference; i.e. one which contains only limited information about you, additional
references may be sought.
If you have previously worked overseas the School may take up references from your overseas employers.
The School may also telephone your referees in order to verify the reference they have provided.

Referee 1 Referee 2

Name: Name:

Organisation: Organisation:

Address: Address:

Telephone Telephone
number: number:

Email address: Email address:

Job Title: Job Title:

Relation to you (e.g. current/most recent employer): Relation to you (e.g. previous employer/colleague):

May we contact prior to interview? Yes No May we contact prior to interview? Yes No

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 Section 12: Recruitment

It is the School's policy to employ the best qualified personnel and to provide equal opportunity for the
advancement of employees including promotion and training and not to discriminate against any person because
of their race, colour, national or ethnic origin, sex, sexual orientation, marital or civil partnership status, religion or
religious belief, disability or age. All new appointments are subject to a probationary period.
The School is committed to safeguarding and promoting the welfare of children and young people and expects all
staff and volunteers to share this commitment.
A copy of the School's Recruitment Policy and Child Protection Policy is available for download from the School's
website. Please take the time to read them.
If your application is successful, the School will retain the information provided in this form (together with any
attachments) on your personnel file. If your application is unsuccessful, all documentation relating to your
application will normally be confidentially destroyed six months after the date on which you are notified of the
outcome. Please refer to the School's Retention of Records Policy for further detail on how such information is
retained by the School.

How we use your information

Information on how the School uses personal data is set out in the School's Privacy Notice, which can be
found on our website.

Section 13: Declaration

· I confirm that the information I have given on this application form is true and correct to the best of my
knowledge.
· I confirm that I am not named on the Children's Barred List or otherwise disqualified from working with
children.
· I understand that providing false information is an offence which could result in my application being rejected
or (if the false information comes to light after my appointment) summary dismissal and may amount to a
criminal offence.
· I confirm that, to the best of my knowledge, I am not disqualified from working in early years provision or later
years provision with children under the age of eight.

Signed:

Date:

Where this form is submitted electronically and without signature, electronic receipt of this form by the School will
be deemed equivalent to submission of a signed version and will constitute confirmation of the declaration at
Section 13.

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Appendix 1 Spent convictions and the DBS filtering rules

Spent convictions
Sentence Rehabilitation period
(in all cases the period
commences from the date of the
conviction)

Aged over 18 at Aged under 18

the time of the at the time of
conviction the conviction

 Prison sentence of more than 4 years Never Never

 Sentence of imprisonment, youth custody, detention in a young offender
institution or corrective training of over four years
 Sentence of preventive detention
 Sentence of detention at Her Majesty’s Pleasure
 Sentence of custody for life
 Public protection sentence (imprisonment for public protection, detention
for public protection, extended sentences of imprisonment or detention
for public protection and extended determinate sentences for dangerous
offenders)
 A public protection sentence (the provisions for which are set out in Part
12 of the Criminal Justice Act 2003 and Part 8 of the Armed Forced Act
2006 means a sentence of imprisonment or detention, as detailed above,
imposed for specified sexual and violent offences).

Prison sentence of more than 30 months but less than or equal to 4 years Length of Length of
sentence + 7 sentence + 3.5
years years

Prison sentence, or sentence of detention, of more than 6 months but less Length of Length of
than or equal to 30 months sentence + 4 sentence + 2
years years

Prison sentence, or sentence of detention, of less than or equal to 6 months Length of Length of
sentence +2 sentence + 18
years months

Removal from HM Service 1 year 6 months

Service detention 1 year 6 months

Community order or youth rehabilitation order 1 year 6 months

Fine 1 year 6 months

Compensation order Once paid in full

Absolute discharge Spent immediately

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 Driving disqualification End of the disqualification

Driving endorsement 5 years from 30 months from

the date of the date of
conviction conviction

Relevant order (include conditional discharge orders, restraining orders, End of the order or, if no date
hospital orders, bind overs, referral orders, care orders and any order imposing given, 2 years from the date of
a disqualification, disability, prohibition or other penalty not mentioned in this conviction – unless the order
table) states ‘unlimited’, ‘indefinitely’ or
‘until further order’ as in these
cases it will remain unspent

Simple caution, youth caution Spent immediately

Conditional cautions, youth conditional caution 3 months or when caution ceases

to have effect if earlier

Filtering rules

You are not required to disclose information about spent criminal convictions for offences committed in the
United Kingdom if you were over 18 years of age at the time of the offence and:
· 11 years have elapsed since the date of conviction;
· it is your only offence;
· it did not result in a custodial sentence; and
· it does not appear on the list of "specified offences".

You are not required to disclose information about a spent caution in relation to an offence committed in the
United Kingdom if you were over 18 years of age at the time of the offence and six years has elapsed since the
date it was issued, and provided it does not appear on the list of "specified offences".
You are not required to disclose information about a spent criminal conviction if you were under 18 years of age
at the time of the offence and:
· five and a half years have elapsed since the date of conviction;
· it is your only offence;
· it did not result in a custodial sentence; and
· it does not appear on the list of "specified offences".

You are not required to disclose information about a spent caution if you were under 18 years of age at the time
of the offence and two years has elapsed since the date it was issued, and provided it does not appear on the list
of "specified offences".
The list of "specified offences" that will always be disclosed can be found at:
https://www.gov.uk/government/publications/dbs-list-of-offences-that-will-never-be-filtered-from-a-criminal-
record-check

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