Job Application Form Step 1 of 8 12% Position Applied For*Job Reference Number*Title*Surname*Forename(s)*Previous Surname(s)Address* Street Address City Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone Number*Mobile Phone Number*Email* Work Phone NumberMay we call you at work?YesNoNational Insurance Number*Please give dates/times when you will not be available for interview*Please give details of any pension schemes to which you belongWhere did you hear about this job?* Section 2Current or most recent employment (give details of your present or most recent work)Employer’s name and address*Contact number:Job titleFrom Date Format: DD slash MM slash YYYY To Date Format: DD slash MM slash YYYY Notice requiredCurrent salary and gradeBrief description of current duties and responsibilitiesReason for leaving (if applicable)Section 3Please list all the jobs you have had following on from your most recent post and include details of voluntary work and/or employment on a temporary contract or via an employment agency. You must account for all your time since leaving school and provide details of any gaps in employment below. Continue on a separate sheet if needed and attach it belowcontent hereEmployer NameEmployed from Date Format: MM slash DD slash YYYY Employed to Date Format: MM slash DD slash YYYY Reason For LeavingSalary (on leaving)Position heldBrief description of dutiesEmployer 2Employer NameEmployed from Date Format: MM slash DD slash YYYY Employed to Date Format: MM slash DD slash YYYY Reason For LeavingSalary (on leaving)Position heldBrief description of dutiesEmployer 3Employer NameEmployed from Date Format: MM slash DD slash YYYY Employed to Date Format: MM slash DD slash YYYY Reason For LeavingSalary (on leaving)Position heldBrief description of dutiesEmployer 4Employer NameEmployed from Date Format: MM slash DD slash YYYY Employed to Date Format: MM slash DD slash YYYY Reason For LeavingSalary (on leaving)Position heldBrief description of dutiesPeriods of non-employment Indicate nature/reasons for any non-employment including datesUpload a file with more information if necessary 4. Education, training and qualifications4. Education, training and qualificationsName of institutionCourseDate from & toQualification obtained Starting with the most recent please provide accurate details, dates and grades for all the educational establishments and qualifications relevant to the job you are applying for, and include any listed in the person specification. Shortlisted applicants are required to bring to the interview the original certificates of all qualifications listed. Or, you will be asked to provide them if a conditional offer is made to you. (Please continue on a separate sheet if necessary and attach it to your form.)5. Membership of professional bodies/professional qualificationsName of bodyQualification of membership (class/grade)Date obtainedWas membership gained by examination?Is membership still current? Please provide details of your membership and relevant membership number.I understand that I must provide original evidence of the highest or most relevant qualifications listed above and that failure to do so may result in a job offer being withdrawn. (Please tick) Tick 6. Further information on knowledge, skills, abilities and experience*Please use this space to tell us how you meet the job requirements that are listed in the person specification. You must address all items in the person specification to allow us to assess your suitability to be shortlisted and put forward for the selection process. Supply evidence of your strengths and give clear, relevant examples of your experience, skills and knowledge when addressing each requirement. Your evidence may include skills and experience gained in employment, voluntary work, community or leisure activities. You may attach a CV but it must be in addition to the information you provide here.Upload CV 7. RefereesPlease provide full details of two referees: one must be your present or most recent employer and the other should be a previous employer. If you have not been in paid employment please give the name of the head of education or training establishment that you attended and/or the manager of a voluntary group for whom you have worked. Please note, Enable has the right to seek a reference from any previous employer/school/college/university and take up more than two references.We may wish to take up references prior to interview; if you are shortlisted:May we contact your first referee before interview?*YesNoMay we contact your second referee before interview?*YesNoName of 1st refereeJob titleOrganisationAddressDate of employment/studyDate From Date Format: MM slash DD slash YYYY Date to Date Format: MM slash DD slash YYYY Relationship with referee (e.g. line manager)Phone NumberEmailName of 2nd refereeJob titleOrganisationAddressDate of employment/studyDate From Date Format: MM slash DD slash YYYY Date to Date Format: MM slash DD slash YYYY Relationship with referee (e.g. line manager)EmailPhone Number 8. RelationshipAre you related to, or do you have a friendship or close personal/business association with, any employee of Enable Leisure and Culture?*YesNoIf YES, please give their full name and the relationship9. Employment restrictions9a Visa*YesNoAre there any restrictions or conditions affecting your ability to take up or remain in employment in the UK? E.g. do you require a work permit? Are you a highly skilled migrant or a working holidaymaker?If YES, please give details, including – if you are already in the UK – details of your current employer, visa/leave to remain, expiry date, certificate of sponsorship number and tier under which you are employed.9b Working time regulations*YesNoIf you are offered this job will you have any other paid work?If YES please provide the followingEmployer(s)AddressPhone NumberNature of workDate employed from Date Format: MM slash DD slash YYYY to Date Format: MM slash DD slash YYYY Number of hours a weekWorking times/daysAre these arrangements subject to change (e.g. shifts)YesNoIf YES, please give detailsDo you have any requirements to allow you to take part in an interview?YesNoIf yes please specify 10. DeclarationProviding any misleading or false information to support your application or canvassing staff of Enable LC directly or indirectly for an appointment will disqualify you from appointment, or if appointed will render you liable to dismissal without notice.I hereby declare that I have understood and complied with the requirements laid down in the previous paragraph (please tick)* Tick DATA PROTECTION ACT 1998 I understand that the information given on this form will be used by the employer, Enable Leisure & Culture, for: • the purpose of processing my application for employment, • monitoring Enable LC’s employment policies; and if my application is successful, • recording information relevant to my employment. I understand that any information given relating to racial or ethnic origin, physical or mental health and criminal convictions constitutes sensitive data as defined by Section 2 of the Data Protection Act 1998. I hereby consent to the processing by Enable Leisure & Culture for the purposes set out above of all information given by me including such information as constitutes sensitive data. Equal opportunities recruitment monitoring formTo make sure that recruitment and selection is being carried out fairly and to help check that Enable LC’s equal opportunities in employment policy is working, Enable records the race, gender, disability and age of people who apply for its jobs. This form will not inform assessment or be shared with the selection panel. You are asked to answer the following questions. Thank you for your assistance.Position applied for*Post ref numberSurname*First Name(s)*Gender*MaleFemaleDate of birth* Date Format: DD slash MM slash YYYY Are you currently employed by Enable LC?*YesNoPlease read the following carefully before placing a tick in the appropriate box. I would describe myself as being the following:1. White British Irish Any other White background e.g. European. Please specify 2. Mixed White & Black Caribbean White & Asian White & Black African Any other mixed background. Please specify 3. Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background. Please specify: 4. Black or Black British Caribbean African Any other Black background. Please specify: 5. Chinese or other ethnic group Chinese Any other. Please specify: DisabilityEnable is keen to encourage disabled people to apply for jobs at the company. The following information is sought for monitoring purposes.a) Do you consider yourself to have a disability, which is defined in the Equality Act 2010 as ‘a physical or mental impairment and the impairment has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities’?*YesNoIf yes, please indicate the nature of your disabilityDo you require any adjustments in relation to your disability?YesNoIf yes, please specify the required adjustments:Enable operates the following equal opportunities in employment policy, which has been jointly agreed with representatives of its staff: - “It is the policy of Enable that there be equal opportunity for employment in its service and equable terms and conditions for all staff, and that all employees be recruited, trained and promoted on the basis of their ability, their fitness for the work and the requirements of the job. Enable instructs the Managing Director and each manager, supervisor or other officer with duties on behalf of Enable as employer and all employees – a) to ensure that the terms of the Equality Act 2010 and this policy are observed, and that no unlawful discrimination is permitted on grounds of religion or belief, colour, race, nationality or ethnic or national origins, marital status, sex, sexual orientation, disability or age; and b) to ensure a positive attitude towards equality of opportunity and the administration of staff policies to that end. Managers are instructed to ensure that the terms of this policy are communicated to each employee, with guidance in the use of Enable’s harassment procedure or grievance procedure as a means of making any complaint of discrimination or failure to accord equality of opportunity.”Declaration* Tick I understand that any information given relating to racial or ethnic origin, physical or mental health and criminal convictions constitutes sensitive data as defined by Section 2 of the Data Protection Act 1998. I hereby consent to the processing by Enable LC for the purposes set out above of all information given by me including such information as constitutes sensitive data.EmailThis field is for validation purposes and should be left unchanged.