Please complete this form in black For Office use

ink or typescript and return it to:

CONFIDENTIAL
Wetherby High School
Hallfield Lane
Wetherby
The information you provide on this form will be LS22 6JS Ref:
used for recruitment & selection and employment
[email protected]

Post Applied For: Grade: Closing Date:

Title: Legal First Name(s): National Insurance No:

Last Name: Preferred First Name(s):

Address for Correspondence: If the job includes driving, are you licensed to drive the
appropriate vehicle? If you hold an HGV licence, please state
class. YES NO (Please delete as appropriate)

Postcode: If you are selected for interview, are there any dates when it
would be impossible for you to attend?:
Home Tel No:
Mobile Tel No:
Work Tel No:
When would you be available for work?:
Email:

May we contact you at work? YES NO

(Please delete as appropriate) Are you related to any Councillor or Employee of Leeds City
Council? YES/NO (If yes, give details)

For Full Time posts:I am applying for Job Share / Part-Time

(please delete as appropriate)
Please indicate the range of days and the maximum number of
hours you are able to work

CRIMINAL CONVICTIONS (Please see the Recruitment Pack and our website for guidance )

Applicants who are shortlisted will be required to provide details of any convictions, cautions, reprimands or final warnings as defined by the
Rehabilitation of Offenders Act 1974 (Exceptions) Order1975 (as amended in 2013). 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’. This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.
Guidance about whether a conviction or caution should be disclosed can be found on our website.
Shortlisted candidates will be sent a self-disclosure form and asked to return this to [email protected] prior to interview/assessment.
Candidates will be asked to sign a copy of this Application Form and their self – disclosure prior to interview. Please see the Information for
Applicants regarding what should be disclosed and what is protected under the Act and should not be disclosed. Further information and guidance
can be found on the Disclosure and Barring Service website. We work in line with the DBS Code of Practice.

References
Please give the names and addresses of two referees. One should be your present employer or, if not employed, your last employer.
If you have not been employed before, you will need to supply referees who are able to comment on your ability to do the job.
1. Title: Name: 2. Title: Name:

Occupation: Occupation:

Address: Address:

Postcode: Postcode:
Telephone No: Telephone No:
Fax No: Fax No:
Email: Email:
Capacity in which known: Capacity in which known:
Unless otherwise stated, referees will be automatically contacted if shortlisted for an interview

Ref 1: Yes/No (Please delete as appropriate) Ref 2: Yes/No (Please delete as appropriate)
 EMPLOYMENT EXPERIENCE
Current or last occupation / position /scheme Date Started: Permanent/Temporary
(Please delete as appropriate)
Date left (if applicable):
Salary: Grade/Scale:
Reason for leaving :
Employer:

Address:

Briefly describe your duties:

Please list all previous jobs and/or work experience, including any voluntary roles
(Most recent first)
Name of Employer Date from Date to Position held and main duties Reason for
Month Year Month Year Leaving

Training and qualifications relevant to the job

Please show here that you have the training and qualifications asked for in the employee Year Awarded
specification, including Apprenticeships and Membership of Professional or Technical Bodies as well as
your secondary, further and higher education history.
 Knowledge
Please show that you have the knowledge asked for in the Employee Specification gained either through work, education,
home or voluntary activities.

Experience
Please show that you have the experience asked for in the Employee Specification gained either through work, home or
voluntary activities.

SKILLS
Please show that you have the skills asked for in the Employee Specification gained either through work, home
or voluntary activities.
 Additional Information
You must not exceed two sides of A4 paper (this does not apply to Disabled Applicants).
Please note CV’s are NOT allowed as an alternative to fully completing this form.

Please show how you meet the additional factors on the Employee Specification and use this section if there is
any other information you wish to add in support of your application.
 Additional Information (continued)

General Data Protection Regulations

Information provided on this Application Form and as part of the recruitment process will be used in line with our Privacy Notice
for applicants. Please see the vacancy pages on our school website for details.

The information you submit will be processed by Wetherby High School. The lawful basis for processing this information is with a view to
entering into a contract with you.

Please note the Equality data is voluntary and collected with your consent. It will be used to monitor the effectiveness of the school’s
policies and practices, in particular its Equal Opportunities Policy. This monitoring is for statistical purposes only and you will not be
identifiable from this process.

Your information may be shared may be shared with Leeds City Council in their role as data processor where they have a legitimate
business need to access it, and externally where required for the recruitment process, for example, in order to obtain references or where
background checks are required. Your information will only be shared where necessary, and in accordance with data protection law.

If successful, this form will be retained on your personnel file and kept for a period of 6 years after the termination of your employment.

Application forms submitted by unsuccessful candidates will be destroyed after six months from the date the post was appointed to.

Information regarding your rights in relation to your personal data are available via the Information Commissioner’s Office: www.ico.org.uk.

Declaration
I consent Wetherby High School and Leeds City Council recording and processing the information detailed in this application form. I can
confirm that, to the best of my knowledge, the information provided on this form is correct and gives a fair representation of my
qualifications and employment history. I understand that if my application is successful my appointment will be subject to satisfactory
criminal vetting under the legislation for the protection of children, including a) references which are satisfactory to the school b) a
satisfactory DBS certificate and check of the Barred list c) the entries on this form proving to be complete and accurate and d) a satisfactory
medical report, if appropriate. I confirm that I have not been disqualified from working with children, cautioned or sanctioned in this regard.

Signed: Date:

If you are submitting this form electronically you will be required to sign a hard copy should you be selected for interview
African BF Chinese CC
Caribbean BC Other (specify) CO
Other (Specify) BO