OIPS FRIENDS PLAYGROUP & AFTERSCHOOL CLUB
APPLICATION FORM
Appliants must ensure that they provide sufficient information on the form to enable the
selection panel to assess their eligibility for consideration. Failure to do so will result in
application being rejected. To facilitate photocopying please complete form in black ink.
Application for Vacancy:
BANK STAFF
Date of application:
Employer:
OIPS FRIENDS
Dergmoney Lane,
9 Ballynahatty Road,
Omagh, BT78 1PN
Closing date: 28TH JANUARY 2016
Personal Details: (Please complete in block capitals)
Forename:
Title (Dr, Mr, Mrs, Miss Ms):
Address:
Surname:
National Insurance no.
E-mail:
Home no:
Mobile no:
Are you eligible to work in the UK? YES/NO
The Management Committee welcomes applications from people with disabilities. If
you have a disability which requires special arrangements for interview please specify
below the assistance you require.
Secondary/ Further Education: Specifically detail when and where you obtained your
qualifications:
Date
GCSE/NVQ Subjects &
Obtained Grades
Date
‘A’ Level (inc grades)
Obtained
College/University Education:
Name of college or Dates
University
Full/
Part-time
Degree Awarded
If honours state class
And division
Subjects taken in
Each year
Subjects taken in
Each year
Additional qualifications:
Please give details of Post-Primary Degrees, Diplomas, Certificates or Membership of Professional
Examining Bodies.
Dates of course
From
Name of Awarding
Or Examining Body
Grade and nature
of Award
Qualifications
To
In-service or other Training Courses:
Please give details of courses attended including provider, dates and brief description of course (e.g.
Hygiene Certificate, Paediatric First Aid)
Employment (beginning with present post if applicable):
Name and Address of
Employer
Post held and Duties
Salary
Dates
From
To
Gaps in Employment History:
Please account for any gaps in your employment history since leaving full-time education.
Relevant Additional information:
Shortlisting will be based solely upon the information provided in this application form. You are
advised to use the space below to explain how you meet the essential and desirable criteria for
the post and include any other information of relevance. (Continue on extra sheet if necessary)
References:
Give the names, addresses and contact details of two referees able to comment upon your
professional competence. At least one of these must be a current or previous employer
who is able to comment upon your suitability to work with children. References may not
be sought from any member of the Management Committee or existing Staff of OIPS
FRIENDS. Prior consent of referees must be obtained for this particular post.
Name
Position
Address
Telephone no.
Email:
Child Protection:
This post is a ‘regulated position’ as defined under the POCVA (NI) Order 2003.
Is there any reason why you would not be suitable to work with children in an educational
setting:
Declaration by Applicant:
I hereby certify and declare that:
a) I have read the terms and conditions of employment pertaining to the position for
which i now make application and declare that the information supplied by me in
this application is correct to the best of my knowledge and belief. I acknowledge
that if i am appointed to the position now sought statements of material fact herein
subsequently discovered to be untrue may be considered by the Management
Committee as sufficient grounds to warrant termination of my appointment on the
grounds of misconduct.
b) I have not, in any manner, canvassed any member of OIPS Friends Management
Committee or Staff nor sought or consented to any manner of canvassing to be
undertaken on my behalf and that from the date hereof i will not undertake, seek or
consent to such canvassing.
c) The information on this form is required for the purpose of processing your
application. The information is covered by provisions of the Data Protection Act
1988. I understand that my signature is authorisation for OIPS Friends to process
and retain the information for the purpose stated.
d) If my application is successful i will supply copies of all qualifications and course
certificates listed herein.
e) In the event of my application being successful i consent to an AccessNI check being
made- the cost of which I will be liable for to determine if there is any record of
convictions, cautions or bind-overs against me.
Signature of Applicant: ............................................................................................
Date: .......................................
The completed form accompanied by the Monitoring form should be returned by the date
and time given to the Management Committee, OIPS FRIENDS, Dergmoney Lane, 9
Ballynahatty Road, Omagh, BT78 1PN. Late applications will not be considered.
Equal Opportunities Monitoring Questionnaire
Job Ref: ________App Code: ________
National Insurance Number:
AGE – Please enter your date of birth: _ _ / _ _ / _ _ _ _ (e.g. 05/08/1948)
SEX – I am: Male [ ] Female [ ]
COMMUNITY BACKGROUND –
I am: A member of the Protestant Community [ ]
A member of the Roman Catholic Community [ ]
Not a member of either the Protestant or Roman Catholic Communities [ ]
DISABILITY
I have: No disability [ ]
A physical impairment, such as difficulty using arms or, mobility requiring a wheelchair or crutches [ ]
A sensory impairment, such as blind/visual impairment [ ] or deaf/hearing impairment [ ]
A mental health condition, such as depression or schizophrenia [ ]
A learning disability, such as Down’s Syndrome, dyslexia or cognitive impairment such as autism [ ]
A long standing illness, such as cancer, HIV, diabetes, chronic heart disease or epilepsy [ ]
Other .............................................................................................................................................
STATUS
I am: Single (never married) [ ] Married (living with spouse) [ ] Married (separated) [ ]
Civil partnership (same sex) [ ] Divorced [ ]
Other ................................................................................................................................
RACE, COLOUR OR ETHNIC/NATIONAL ORIGINS
I am: White [ ] Chinese [ ] Irish Traveller [ ] Indian [ ] Pakistani [ ] Bangladeshi [ ]
Black African [ ] Black Caribbean [ ] Black Other ....................................................
Mixed Ethnic Group ........................................ Other .................................................
NATIONALITY –
Please specify: ............................................................................
SEXUAL ORIENTATION – My sexual orientation is towards:
Persons of a different sex to me, I am a heterosexual man or woman [ ]
Persons of the same sex as me, I am a gay man or lesbian [ ]
Persons of both sexes, I am a bisexual man or woman [ ]
DEPENDANTS/CARING RESPONSIBILITIES –
Please indicate if you have dependants or persons you have responsibility for (if anyone):
No dependants or caring responsibilities [ ] Child or children [ ] Disabled person(s) [ ]
Elderly person(s) [ ] Other: .........................................................................................
ADVERTISING – Please name any newspapers and/or websites where you learned of this job:
........................................................................................................................................................
DO NOT SEPARATE THIS FORM FROM THE JOB APPLICATION FORM