<p> NORBURY MANOR BUSINESS AND ENTERPRISE COLLEGE Kensington Avenue Tel: 0208 679 0062 Thornton Heath Fax: 0208 679 8007 Croydon CR7 8BT email: [email protected]</p><p>APPLICATION FORM – SUPPORT STAFF If sending or faxing, please complete in black ink to facilitate photocopying.</p><p>POST APPLIED FOR:</p><p>1. PERSONAL DETAILS FULL NAME PRIVATE ADDRESS TELEPHONE Surname: Home:</p><p>Other Names: Business/ Daytime: Mrs/Mr/Ms/Miss: Post Code: ( pls state Marital status) Mobile: Former Names: Nat Ins No:</p><p>Date of Birth: Email:</p><p>2. EMPLOYMENT DETAILS (for the last 5 years – please continue on separate sheet if necessary) Employer – Name and Position Held and Main Dates – From Please give address Duties (inc and To reason for grade & salary) leaving Present/most recent:</p><p>Previous: 1.</p><p>2. 3. EDUCATION AND QUALIFICATIONS SECONDARY EDUCATION Place of Study Dates To and Qualifications gained Grades School/College From CSE/GCE PT or FT ‘O’level/GCSE/etc (please give grades)</p><p>FURTHER EDUCATION</p><p>Place of Study Dates To and Qualifications gained Grades College/Poly/Uni/etc From ‘A’ PT or FT levels/Diploma/GNVQ/ Degree/etc</p><p>4. MEDICAL HISTORY How would you describe your health?</p><p>How many days absence have you had in the last two years?</p><p>Please note: If you are successful in your application you may have to fill in a medical questionnaire? Are you registered as a disabled person? 5. REFERENCES Please give the name and address of two persons who may be consulted regarding your suitability for this post. Full Name: Address: Capacity in which they are known to you: Present or most recent employer:</p><p>Daytime tel no: Email: Other Referee:</p><p>Daytime tel no: Email:</p><p>Are you related to a Governor of the College: YES/NO</p><p>A Candidate who fails to disclose such a relationship shall be disqualified for the appointment and if appointed shall be liable to dismissal without notice. Any canvassing will disqualify candidates.</p><p>6. IMPORTANT INFORMATION The post for which you are applying involves substantial opportunity for access to children. It is therefore exempt from the Rehabilitation of Offenders Act 1974. You are therefore required to declare any convictions or cautions you may have, even if they would otherwise be regarded as ‘SPENT’ under this act. The information you give will be treated in confidence and will only be taken into account in relation to an application where the exemption applies. The College is also entitled under arrangements for the protection of children, to check with the Police for the existence and content of any criminal record of the successful applicant. Please complete the enclosed Self Disclosure form, place in a sealed envelope and return with your completed application form.</p><p>Information received from the Police will be kept in strict confidence and will be destroyed immediately the selection process is completed. The disclosure of a criminal record will not debar you from an appointment unless it is considered that the conviction renders you unsuitable for the appointment. If you are selected for the post for which you are applying you will be required to disclose information of such convictions/cautions and to consent to an enhanced CRB check. Information supplied may be used for registered purposes under the terms of the Data Protection Act 1998. 7. SUPPORTING STATEMENT You are encouraged to add any additional relevant information about yourself and the skills and experience which you consider fit you for this post.</p><p>(Please ensure that you write only one side of A4 paper in size 12 font – thank you) </p><p>I declare that to the best of my knowledge all parts of the form have been completed and are accurate.</p><p>Date:</p><p>The College is committed to safeguarding and promoting the welfare of children.</p><p>Office use only Identity check Qualification check Right to work in UK Enhanced CRB check</p>