NATIONAL FIREFIGHTER SELECTION FIREFIGHTER RETAINED DUTY SYSTEM APPLICATION FORM

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3 Personal Details Any information provided on this form will remain confidential. It will be held manually and on an electronic database within the Human Resources Department and will form part of your personal record profile. Information will not be disclosed to any third party not directly involved with this application and you have the right to request removal of these details from our files at any time before an offer of employment is made. Family name: First name: Date of application: Date of birth: Addresses: Home Distance from Fire Station: miles Work Distance from Fire Station: miles From which address would you be attending incidents? Home Work Both Daytime contact number: Evening contact number: address: Station applied to: How did you hear of this vacancy? I confirm that I have completed this application form and that to the best of my knowledge the information I have provided in it is true and correct. I agree to the information in this form being stored for the purposes of my application and for reasonable research into the application process, in accordance with the Data Protection Act. Signed: Date: Please note: Approaching any elected councillor or employee of a Fire and Rescue Authority directly or indirectly to promote this application or providing false/misleading information in this form shall disqualify you from appointment or if appointed may render you liable to disciplinary action, which could lead to your dismissal.

4 Availability Sheet When considering your application, we will need to take into account the times that you can be available to respond to fire calls and whether this is in line with the needs of the Station. When completing this form, please give consideration to your existing commitments, as the availability you state here will form part of your contract of employment with us, should you be successful through the recruitment process. Please shade the times that you intend to provide cover and complete the totals at the bottom Total hours per day Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total hours per week If you are unable to complete this form because of a rolling shift pattern, please enclose a brief description using an additional signed sheet of paper, including the average hours of cover you will be able to offer. Signed: Name: Date:

5 Equal Opportunities in Employment Monitoring Form Completion of this section is voluntary, but the information will help us to ensure equality of opportunity. You should only supply us with information about yourself that you are comfortable with sharing at this point. This information forms no part of the recruitment process. It will be detached from your application on receipt. If however, you would like to discuss any reasonable adjustments that you require at any stage of the recruitment process, please contact the HR Department. The Fire and Rescue Service is an equal opportunities employer and is determined to ensure that: The workforce reflects the diverse society that it serves and the working environment is free from any form of harassment, intimidation, bullying or victimisation. All job applicants and employees will be treated fairly and will not be discriminated against on any grounds. No job applicant or employee is disadvantaged by conditions or requirements that cannot be justified by the requirements of the job. The information on this form is for monitoring purposes only and will not be made available to those assessing your application. The information will be treated in the strictest confidence and will not affect your job application in any way. (Please cross the relevant boxes) Age or over Prefer not to say Gender Male Female Do you identify as Trans? Yes No Prefer not to say Do you regard yourself as belonging to any particular religion or belief? Yes No Prefer not to say If you answered Yes, which one? Buddhist Christian Hindu Jewish Muslim Sikh Other - Please specify: Sexual Orientation Bisexual/Bi Gay Man Lesbian/Gay Woman Heterosexual/Straight Other Prefer not to say

6 To which of these ethnic groups do you feel you belong? White British Irish Other Mixed White and Black Caribbean White and Black African White and Asian Other Asian or Asian British Indian Pakistani Bangladeshi Other Asian Black or Black British Caribbean African Other Black Chinese Chinese Other Gypsy Travellers Romany gypsy Irish traveller Other Prefer not to say Other Ethnic group If your ethnic group was not specified in the list please describe your ethnic group: The Disability Discrimination Act (DDA) describes a person as disabled if they have a long-standing physical or mental condition that has lasted or is likely to last at least 12 months; and this condition has a substantial adverse effect on their ability to carry out normal day-to-day activities. Do you consider yourself to have a disability? Yes No Prefer not to say If you have a disability it would be helpful for us to have a better idea of what the disability is. If you answered yes, please tick the category or categories that apply to you. Physical impairment Mental health condition Sensory impairment (hearing and sight) Learning disability (eg dyslexia) Long standing illness or health condition, such as cancer, HIV, heart disease, diabetes or epilepsy Prefer not to say Other - Please specify: