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JOB APPLICATION FORM CITY AND ISLINGTON COLLEGE Please carefully complete each section of the form in black ink or typewritten. POST APPLIED FOR: A. PERSONAL DETAILS Surname: First Names: Title: Other surnames you have been known by: Address: Post code: Home Work Mobile Email address: Do you require a work permit to work in the UK? Guidance Notes for Applicants, to ensure your application is accepted. National Insurance No: Yes [ ] No [ ] *If you select yes, please refer to B. PRESENT OR MOST RECENT EMPLOYMENT Employer: Address: From: To: Salary: Job Title: Grade if applicable: Main Responsibilities: Notice Period: Reason for Leaving: 1

C. EMPLOYMENT HISTORY Please give details of all previous employment starting with the most recent (including periods of unemployment). If you are still in full time education, please give details of any vacation or part time employment. The information given may be used to obtain references at a later date. Employer Employed from / / Employed to / / Position held, duties and reasons for leaving Please continue on a separate sheet using the same format if necessary 2

D. EDUCATION AND QUALIFICATIONS Starting with the most recent: Secondary/Further School / College or University Subject or Course Examination e.g. GCSE Grade Highest Level Qualification achieved in English & Maths School / College or University Subject or Course Examination e.g. GCSE Grade Teaching Qualifications and Assessor Awards From To Qualification / Award Obtained at If you have qualified teacher status, please provide your Teacher Reference Number. (This is sometimes referred to as TRN, QTS or Dfe and is a seven digit number in the format NN/NNN) Teacher Reference Number: IFL: Institute for Learning number: GTC: General Teaching Council number: Membership of Professional Organisations / Bodies Date Membership and Level Relevant Training Courses Attended From To Training Provider Course Title For Teaching and Lecturing posts the information that you provide in Sections C & D will be used to assess starting salary. 3

E. SUPPORTING STATEMENT In this section you must give full details of how your skills, abilities and experience match the person specification of the post that you are applying for. Please continue on a separate sheet if necessary. (Please note that CV s will not be accepted.) 4

F. REFERENCES Please give the details of two referees who can verify your employment record and give information about your suitability for this post. Reference must be from your last two employers within the last 5 years and must include one current and one previous employer. If you have worked for one employer, for your second reference please chose someone who can comment on your ability to meet the requirements of the job. If you have not been in paid employment, one reference must be from a School/College/University and one from someone who can comment on your ability to meet the requirements of the job. If you are currently working in a senior role in a School or College, one of your referees must be the Principal of the College or the Head Teacher of the School. Where necessary, previous employers who have not been named as referees will be contacted in order to clarify any anomalies or discrepancies. Referee email address must be a company email address. Personal email addresses will not be accepted. When does the College seek references? 1. References will be sought prior to interview for all teaching roles at City & Islington Sixth Form College only 2. For all other roles within City and Islington College, please tick this box if you do not wish us to seek your references prior to interview Name: Job Title: Name: Job Title: Address: Address: Tel Fax Number: Email Address: (Must be a company email address) Tel Fax Number: Email Address: (Must be a company email address) 5

G. DISCLOSURE OF CRIMINAL RECORD All candidates for posts which give them access to children or young people are required under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, if offered an appointment, to disclose details of all previous convictions. Disclosure of any criminal conviction(s) will not necessarily debar you from employment with the Corporation - this would depend on the nature of the offence(s) and their relevance to this appointment. Failure to declare previous convictions may prevent your employment if it subsequently becomes apparent that you do, in fact, have a criminal record. Any employment offered by the Corporation will be subject to completion of a Criminal Records check and receipt by the Corporation of a satisfactory Disclosure certificate. Please answer the following questions: Do you have any unspent convictions, cautions, reprimands or warnings? Yes No If yes, please provide details H. RELATIVES Are you related to an employee or governor of the College? Yes No If yes, please give details: I. HOW DID YOU HEAR ABOUT US? To help us monitor our advertising, please state where you first saw this post advertised: TES FE Jobs The Guardian Referred by a staff member Total Jobs Job Centre Islington Gazette Camden Journal Other, please state: If you have been referred by a staff member, please state their name: 6

PLEASE READ THE FOLLOWING DECLARATION CAREFULLY BEFORE SIGNING THIS FORM I declare that the information given in this application is to the best of my knowledge complete and correct. I understand that the Corporation reserves the right to seek verification of any information provided. I understand that if it is discovered that I have given false information I may be dismissed from the Corporation s employment. I suffer no legal impediment to taking up appointment. The Corporation complies with the Data Protection Act 1998. I agree to the Corporation using the information contained in this form for the proper administration of the recruitment process and should I be successful I agree that the information will be used as part of the employment relationship. DES/DFE/IFL reference number if applicable: Signature... Date...... Name (Print)...... 7

J. EQUALITY MONITORING FORM City and Islington College is committed to ensuring that Equality and Diversity is integral to all of our work at every level. We actively promote Equality & Diversity in our workforce, in our policies and in our employment practices and selection process. To help us find out how well we are succeeding in providing equal access to employment opportunities, the College needs the information detailed below. This information will not be used in any part of the recruitment or selection process. It will be used by the Human Resources for the purpose of statistical monitoring. The Equality Monitoring Form is separated from your application form as soon as it is received and it is not passed onto anyone involved in the recruitment or selection process. Job Applied for: Reference Number: Grade: Your Full Names: 1. Date of Birth 2. Gender Female Male Prefer not to say 3. Have you ever identified as transgender? Yes No Prefer not to say For the purpose of this question, transgender is defined as an individual who lives, or wants to live, full time in the gender opposite to that they were assigned at birth. 4. Your sexual orientation Bisexual Gay man Gay woman / lesbian Heterosexual Prefer not to say Other (specify if you wish): 5. Your race or ethnic origin Asian or Asian British Bangladeshi Indian Pakistani Any other Asian background Black or Black British African Caribbean Any other Black background Chinese or other ethnic group Chinese Prefer not to say Mixed White and Asian White and Black African White and Black Caribbean Any other Mixed background White British Irish Any other White background Other (specify if you wish): 6. Your religion or belief Which group below do you most identify with? 8

No religion Baha i Buddhist Christian Hindu Jain Jewish Muslim Sikh Prefer not to say Other (specify if you wish): 7. Do you consider yourself to have a disability according to the terms given in the Equality Act? Yes No Prefer not to say The Equality Act 2010 provides protection for people who have disability. The Act defines a person with a disability as an individual who has a physical or mental impairment, which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) and has an adverse effect on the person s ability to carry out normal day-to-day activities. 8. If you have answered yes, please indicate the type of impairment which applies to you: People may experience more than one type of impairment, in which case tick all the types that apply. If your disability does not fit any of these types, please mark other. Physical impairment, such as difficulty using your arms or mobility issues which means using a wheelchair or crutches. Sensory impairment, such as being blind / having a serious visual impairment or being deaf / having a serious hearing impairment. Mental health condition, such as depression or schizophrenia. Learning disability, (such as Down s syndrome or dyslexia) or cognitive impairment (such as autism or head-injury). Long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy. Other, such as disfigurement (specify below if you wish). Please email your application form to: jobs@candi.ac.uk or by post to HR, 383 Holloway Road, London, N7 0RN. 9