2019 Application Form Personal details Surname Title Forenames

2019 Application Form Personal details Surname. . . . . Title. . . Forenames. . . . Previous name (if applicable). . . . Which job are you applying for? . . . . . Date of birth (for ID purposes). . . What centre are you applying to work at? (if no preference please state any) National Insurance number. . . . . Nationality………………………. . . . . . Do you have the legal right to work in the UK? YES / NO From date …………………. . . To date…. . . . If applying for part time work what days / hours are you available Contact details Address. . . . . . . . . Postcode. . . . When are you available to work? . . . . . Other details Do you hold a full EU driving licence? Contact Number. . . Email. . . . . If ‘yes’ date passed. . . Country of issue. . . Lived abroad? Have you lived outside the UK for 6 months or more in the last 5 years. Please give details YES / NO. . . . . . . . . . Why do you want to work on a children’s activity centre in the UK? Experience in relation to the role: Academic & Vocational Qualifications (with dates): Please continue to the next page

Your history Please list all previous employment, education, volunteering, gap year/career break projects from the past 7 years, starting with the most recent. Explain all gaps of 2 months or more (please use an additional sheet if needed): Employer / Organisation …………………………. Job title …………………………………………. . Dates: From……………. . . to ……………. . Reason for leaving ……………………………. Duties: Employer / Organisation ……………. Job title ……………………. . Dates: From……………. . . to ……………. . Reason for leaving ………………. Duties: References Professional referees only from the last 3 years. No friends, family or neighbors. We will contact referees prior to you starting your employment. Include your current or most recent employer / education provider. Name…………………………. Company ……………………. . Address ……………. . . ………………………………………………. Position ……………………. . . . Work email ………………………………………. . . . . Tel. number ……………………………………………. . Post Code ………………………………… Name……………. Company …………. . Address ……………. . …………………………. Position …………. . Work email ……………………. . Tel. number ………………………. . Post Code ………………… Please continue to the next page

Your suitability I understand any position will be subject to a satisfactory Disclosure and Barring Service (DBS) Certificate or Police check from any country I have lived in for 6 months or more over the last five years. Do you have any convictions, cautions, reprimands or final warnings which are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (amendment) (England Wales) Order 2013? Is there any other information which may have a bearing on your suitability for the post you have applied for, such as police enquiries undertaken following allegations made against you? Are you barred from working with young people? Yes / No Are you disqualified from working with young people under the Childcare (Disqualification) Regulations 2009? A person may have been disqualified through: • Having certain orders or other restrictions placed upon them • Having committed certain offences Relevant Offences can be found here: https: //www. gov. uk/government/publications/disqualification-under-the-childcare-act-2006 I have read and checked the list and confirm: that I am not disqualified that I am disqualified □ □ If you have answered Yes to any of the above questions please provide details on a separate sheet of paper. Declaration • I agree to the employer using the information in this form for the purpose of evaluating my suitability for employment • I certify that the information given in this application is true and correct and that if offered employment, any material changes to the information supplied will be declared. I understand that if I am employed by the employer and have given any false or inaccurate information on this form, I will be subject to the company’s disciplinary procedures, which could result in my dismissal. • I give consent for the employer to contact my referees. Signed……………… Date …………………