Application for Employment

School Support, Social Care or

Library Posts

CONFIDENTIAL

Post details

Post applied for Teaching Assistants Reference

School/ Team/ Library name Gosford Hill School Post location Kidlington

Personal details

Title (Mr, Mrs, etc.) Mrs

First name Alethea

Middle name Nerina Charmaine

Surname (family name) Jolly

All previous surnames Taylor Jones Wheeler

National Insurance number NA592477C

Address details

House name/ number & street 1

District Cherwell

Town Bicester

County Oxfordshire

Postcode OX27 8RU

Home phone Area code O1869 number 345609

Work phone Area code number

Mobile phone 07799254015

Email address

Preferred contact method By Phone

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Current employment or occupation

Current occupation (or course Nursery Nurse

details if currently a student)

Employer’s name and address Mad Hatters Murdock Road Bicester

(or school/ college/ university)

Current salary Twelve Thousand PA

Date started (month/ year) October 1st

Previous employment or occupation

Please give details of all other jobs you have held, including part-time and voluntary work, starting
with the most recent. If you need to add further jobs, please put these in the Relevant Skills and
Experience section. Please give a brief explanation for any gaps in employment in the Relevant
Skills and Experience section.

Job title Nursery Nurse

Employer's name Bugz & Budz

Date started (month/ year) 27th March 2007

Date left (month/ year) 28th September 2007

Reason for leaving Made Redundant

Job title Shop Assistant

Employer's name Asda

Date started (month/ year) September 2003

Date left (month/ year) August 2007

Reason for leaving Moved back to Bicester

Job title Nursery Nurse

Employer’s name Leapfrog Day Nursery

Date started (month/ year) December 2002

Date left (month/ year) 2003

Reason for leaving Moved to north wales

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Job title Assembly Operater

Employer’s name Huber & Suhner

Date started (month/ year) July 2000

Date left (month/ year) December 2002

Reason for leaving Made Redundan

Job title Home Care Assistant

Employer's name Cherwell Care Bicester

Date started (month/ year) 1989

Date left (month/ year) 1999

Reason for leaving Left due to hours being cut

Job title Creche Superviser

Employer’s name Cherwell District Council

Date started (month/ year) 1990

Date left (month/ year) 1997

Reason for leaving Left to have a Baby

Job title

Employer's name

Date started (month/ year)

Date left (month/ year)

Reason for leaving

Job title

Employer's name

Date started (month/ year)

Date left (month/ year)

Reason for leaving

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Qualifications

Please list any qualifications you have gained or are undertaking (e.g. GCSEs, A-levels, degree,
NVQs, professional qualifications). If you are shortlisted for interview you will be required to
produce original certificates (or other documentary proof of qualifications) where these are
specified as an essential requirement of the post.
If you need to add further qualifications, please put these in the Relevant Skills and Experience
section.
Name at time of qualification (if different)

Name of qualification Subjects and grades or School/ College/ Date awarded

results expected University attended (month/ year)

C.S.E Mathes Grade 4 Bicester c c 1980

C.S.E English Grade 3 Bicester c c 1980

C.S.E History Grade 3 Bicester c c 1980

C.S.E French Grade 4 Bicester c c 1980

C.S.E Child Care Grade 2 Bicester c c 1980

C.S.E Home economics Grade 2 Bicester c c 1980

Membership of professional bodies

Please give details of any professional bodies to which you belong. If you need to add further
bodies, please put these in the Relevant Skills and Experience section.

Name of professional body Level of Membership Date of

membership number membership

Training

Please list any additional training you have undertaken which is relevant to the post for which you
are applying. If you need to add further items, please put these in the Relevant Skills and
Experience section.

Name of course Date completed

(month/ year)
City & Guilds in Creche work 1992

Foundation certificate in food hygiene 2002

Level 2 award in food safety in catering 2007

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Relevant skills and experience

Please give details of any experience and skills that you feel are relevant to the post and
particularly to the selection criteria listed for the post.
Describe your duties in your present job if appropriate, and details of experience and skills gained
in previous jobs and any other areas such as temporary work, voluntary work, studies or spare-
time activities. Please be specific and give examples wherever possible – these can be drawn from
any aspect of your life.

When doing training for child care i've worked with children who have had some learning
difficulties, i've trained with children up to age of 8, it was very rewarding and enjoyable. When i
worked in the creche for 7 years we had children come in with autisum, they needed a lot of
patience and time ive learnt a lot from children and adults who have special needs and that is
always to be calm and encourage them in what they want to achieve and most of all be a good
listener.
Continue on separate sheet if necessary.

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Referees

Please give details of at least two referees who can confirm that you meet the selection criteria for
the post. Your referees should not be related to you in any way nor writing solely as a friend.
If you are (or have recently been) employed, one must be your current or last employer.
If you are (or have recently been) a student, one should be a senior staff member from your place
of study.
If you are applying for any job in a school or working with children in any other setting, and you are
not currently working with children but have done so in the past, one referee should be that
employer.
If you are applying to work with vulnerable adults and have worked in a care organisation, one
referee must be that employer.
Please note that we normally take up references for all shortlisted candidates and may approach
previous employers for information to verify particular experience or qualifications before interview.

Referees: Referee 1 Referee 2 Referee 3

Title MISS Miss Miss

First name Vikki sue Tracey

Surname Lowe Fletcher jones

(family name)

Position or relationship Manager Manager Superviser

to you

Address Winchmore end Asda stores north 69 princess avenue

wales
stoke lyne bicester buckly flintshire

oxon

Postcode ch7 2lp

Telephone 07894746207 01244834600

(inc. area code)

Fax number
(inc. area code)

Email address
May we contact this Yes Yes / Yes /
referee without further
authority from you?

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Additional details

Is anyone in your household or family an employee, school governor or councillor of Oxfordshire

County Council?
NO
If you have answered "Yes" to the question above, please provide details:

Please give details below of the number of periods of sickness absence from work you have had in
the last two years (your referees will be asked to verify this information if you reach the final stages
of the recruitment process). Any offer of employment will be subject to satisfactory medical
clearance.

Number of periods of sickness absence none

Total number of working days absent none

You may enter any further details with regard to sickness absence (optional)

Do you need a work permit to take up this post? No

If you answered "Yes" to the question above, please provide details

When would you be available to start work? 2 weeks notice

Where did you see this post advertised? (please tick).

Website

Publication * Oxford Times

Other
Please provide details of where you saw this post

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Convictions policy

It is the county council’s policy that you declare any un-spent convictions when you are applying for
a job with us. We are asking you for this information because, as a local authority providing public
services, we have a duty to balance our commitment to help ex-offenders find work with our need
to protect the public and those in the council’s care who are receiving its services. The council’s
policy states clearly that only relevant convictions are taken into account.
Because of the nature of the work for which you are applying we also need you to declare any
spent convictions as this post is exempt from the provisions of section 4(2) of the Rehabilitation of
Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.
If your application is successful and you did not disclose any convictions or other sanctions it could
result in dismissal or disciplinary action being taken against you. Any information you give us will
be completely confidential and will be considered only in relation to the job for which you are
applying.
Please note that any offer of employment will be subject to a disclosure certificate from the
Criminal Records Bureau (CRB).

Convictions

Have you ever been convicted of any offence or received a caution,

No
warning, bind-over or reprimand?

If "Yes", please give details including the offence and the date: Date:

Prosecutions pending

Do you have any prosecutions pending? No

If "Yes", please give details and proposed date of hearing: Date of hearing

Disqualifications

Are you disqualified from working with children or vulnerable adults or

named on any of the following lists: List 99, Protection of Children Act No
(POCA), Protection of Vulnerable Adults Act (POVA)?

If "Yes", please give details: Date

Additional information

Data Protection Statement

The personal information you provide on this application form will be used by the county council for
employment purposes.
If the application is successful, the information will be retained for matters such as payroll,
pensions administration, appraisal of performance, recording details of holiday entitlement,
absences, etc., and monitoring of ethnicity and disabilities for measuring equality of opportunities.
Some of this information, such as health, ethnicity, disabilities and criminal convictions, is defined
as "sensitive" under data protection legislation and by submitting this application form you are
consenting to our processing this for the purposes listed above.
If your application is unsuccessful the information will be retained for 12 months and then the
record will be destroyed.

Declaration

By submitting this form you undertake that the information you have provided is true and accurate
to the best of your knowledge.
The information I have given on this form is true and accurate to the best of my knowledge. I
confirm that I have read the data protection statement contained in this document.

Signed Alethea Jolly Date 08/10/07

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Equal opportunities

Oxfordshire County Council is an equal opportunity employer and is committed to promoting

equality and social inclusion. The county council operates a policy whose aim is to ensure that
unlawful or otherwise unjustifiable discrimination does not take place in recruitment. To help the
county council monitor the effectiveness of this policy (and for no other reason) you are asked to
provide the information requested below.
This information is confidential and does not form part of your application. It will be detached from
your application form when it is received, and the information will not be taken into account when
making the appointment.
I confirm that the information I am giving is accurate and by providing it I am giving my consent to
the county council processing it only for the purposes of monitoring, assessing and developing
employment policies and practices.
The information provided will be held securely on the county council's personnel information
systems in accordance with the principles of the Data Protection Act 1998 for obtaining and
processing "sensitive" personal data and will not be published on an individual basis.

Personal details

Surname Jolly First name Alethea Date of 19/05/63

(family name) birth

1 Gender Male 4 To which of these groups do you consider you

Female * belong? (tick one only)

2 Do you consider that Yes (a) White

you have a disability? No * British * 01
Irish 02
Any other white background 19
(please write in): …………………
(b) Mixed
White and Black Caribbean 21
3 Are you currently Yes White and Black African 22
employed by No * White and Asian 23
Oxfordshire County Any other mixed background 28
Council? (please write in): …………………..
(c) Asian or Asian British
Indian 41
Pakistani 42
Bangledeshi 43
Any other Asian background 44
(please write in): …………………..
(d) Black or Black British
Caribbean 61
African 62
Any other Black background 63
(please write in): …………………
(e) Chinese or other ethnic group
 Chinese 81
Any other ethnic background 85
Thank you for your co-operation (please write in): …………………..

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Information for candidates with a disability

Oxfordshire County Council welcomes applications from all sectors of the community,
including candidates with a disability.

Oxfordshire Employment Service (an Oxfordshire County Council Service) provides

information, advice and guidance on employment-related issues to applicants with a
disability or long term health condition. For more information contact 01865 791606.

The Disability Discrimination Act 1995 defines disability as “a physical or mental

impairment which has a substantial and long-term adverse effect on the ability to carry
out normal day-to-day activities.”

You can obtain further advice from the Disability Rights Commission. Tel: 08457
622633,
text phone 08457 622644, www.drc-gb.org

Arrangements if selected for interview

If you have a disability, please indicate whether you would need any of the following
arrangements to be made if you were invited to interview:

Interview information on audio tape

Interview information in large print format
Sign language or other assistance with communication at interview

Other assistance details:

Induction loop in interview room

Wheelchair-accessible location for interview
Car parking space for interview
Facility for personal carer, assistant or other person to accompany you at interview

Other requirements — please give details:

Arrangements if appointed
Please give details below of any adjustments which would need to be made in order for
you to be able to carry out the duties of the job if appointed.

FOR OFFICE USE ONLY

Post number Closing date (month/ year)
Tick if shortlisted Tick if full-time Grade of post
Tick if appointed Tick if part-time