Application for Post applied for:

Non-Teaching
Employment at The School:

Pioneer Academy
Section 1 - Contact details

Title:

First Name(s): Last Name:

Previous Name(s) (if applicable):

Present Address: Home Address (if different to present address):

Contact Telephone Number:

Contact Email Address:

Section 2 – Employment Record

Present or Most Recent Employer

Full Name of Employer:

Present Employment Address, including postcode: Full/Part Time:

Date Appointed:

Date left and reason for leaving: (if applicable)

Notice period required:

Salary Scale/Grade:

Present Salary: £

Position held and brief description of duties:

 Previous Employers (please list all previous employers from the date of leaving school, including any unpaid or
voluntary posts, starting with the most recent employer first) *

Name and Address of Position held Dates Reason for leaving

Employer Full time or part From/To (please specify any
time gaps in employment)

Continue on a separate sheet if necessary

* All dates from the age of 18 years must be accounted for, including periods of education. Please explain any
gaps in your employment history.

Section 3 – Education, Qualifications and Training, including own school education

Education (please list all qualifications obtained or currently being undertaken, including school education)

Qualification(s) and/or Certificates Dates studied from/to, plus Name and address of School /
gained including subjects & grades date awarded qualification Colleges, Universities or Institutes of
Further Education

2|Page
Training (relevant work related courses)
Course title and subjects covered Date and duration Training provider

Driving Licence (please only answer this question if driving is a requirement of the post, detailed in the person
specification)
Do you hold a current, clean, valid driving licence? Yes No
Please give details if you have answered ‘No’ to the above question:

Do you own or have use of a car? Yes No

Section 4 – Relevant Experience and Skills
Please indicate how you satisfy the criteria set out in the Person Specification by giving specific examples of where
you have demonstrated the skills required from your personal and work experience (paid or unpaid), education
and training. Particular attention should be given to providing examples against each competency listed. Please
refer to the guidance notes for further information. Please continue on a separate sheet if necessary.

3|Page
Section 5 – References

Before completing this section please read the guidance notes attached carefully. References will be taken up if
you are short listed prior to interview.

Current/Most Recent Employer Previous Employer

Name: Name:

Relationship to you: Relationship to you:

Current Job Title: Current Job Title:

Work address: Work address:

Work Tel: Work Tel:

Work E-mail: Work E-mail:

Period known (years): Period known (years):

May this referee be contacted if you are shortlisted? May this referee be contacted if you are shortlisted?
Yes No Yes No

Section 6 – Rehabilitation of Offenders Act – Declaration of Criminal Offences

Before completing this section please read the guidance notes attached carefully. Having a criminal record will not
necessarily prevent you from gaining employment. This post involves access to persons under 18 and is exempt
from the Rehabilitation of Offenders Act 1974 by virtue of the Exception Order. This post is also subject to a
satisfactory Enhanced Disclosure from the Disclosure and Barring Service.

Do you have any warnings, offences, convictions, cautions, bind overs, or are you currently Yes
undergoing criminal investigation? No

If yes please give details of conviction(s) and date(s).

Section 7 – Dismissal, disciplinary or capability procedures

Before completing this section please read the guidance notes attached carefully. This will not necessarily
prevent you from gaining employment.

Have you ever been a subject of disciplinary or capability procedures or been dismissed or Yes
resigned from a position pending disciplinary investigations taking place? If yes please give No
details on a separate sheet.

Section 8 – Asylum and Immigration Act 1996

National Insurance No:

Do you require a work permit to work in the UK? Yes No

4|Page
Section 9 – Declaring an Interest

Please give details if you are related to or have a personal relationship with an Elected Member or Officer of The
Pioneer Academy or if you have any financial interest in contracts with The Pioneer Academy or pending tenders;
or if you are currently employed by The Pioneer Academy:

Section 10 – Additional Information /Special Arrangements

Dates and times when not available for interview:

Any other relevant additional information:

Section 11 – Declaration

Under the terms of the Data Protection Act 1998 and the General Data Protection (GDPR) the information you
provide in this application form and recruitment monitoring form will only be used for the purpose of assessing
your suitability for employment, for monitoring The Pioneer Academy policies and procedures and human
resource management purposes.
If you are unsuccessful this information will be retained on file for at least 6 months. The information may be used
in internal proceedings to consider a complaint about the selection process and/or to defend The Pioneer
Academy against a legal challenge to the fairness of the selection process from any interested party.
The Pioneer Academy is under a duty to protect the public funds it administers and to this end it must use the
information you have provided on this form within its authority for the prevention and detection of crime and
fraud. It may also share this information with other bodies administering public funds solely for this purpose.
I understand the information above and hereby
1) Declare that the information provided in this application form and recruitment monitoring form is correct
to the best of my knowledge and belief. I understand that information that The Pioneer Academy deems
to be false, misleading or incomplete will justify withdrawal of an offer of appointment or my dismissal
from The Pioneer Academy’s service.
2) Agree that the information I give The Pioneer Academy in connection with this application for
employment may be stored and processed for the purposes stated above.
3) Consent to The Pioneer Academy undertaking any checks it may deem necessary in connection with my
application.
4) Agree to The Pioneer Academy asking my previous employers questions regarding my sickness and
disciplinary record and give my consent for my previous employers to disclose this information.
5) Understand that canvassing of Elected Members directly or indirectly in connection with any appointment
shall disqualify me.

Hand signed: ____________________________________________________ Date: ________________________

For Posts involving working with children or vulnerable adults the following declaration must also be completed:
I confirm I am not on the Children’s Barred List, or otherwise disqualified from working with children or vulnerable
adults or subject to any sanctions imposed by a regulatory body (including but not limited to) the General
Teaching Council for England (GTCE), prior to abolition in April 2012, or by the Department for Education or
General Social Care Council (GSCC). I understand that the provision of false information may possibly result in
referral to the police.

Hand signed: ____________________________________________________ Date:________________________

5|Page
Recruitment Monitoring Form
The Pioneer Academy is committed to a policy of equality and diversity for all staff regardless of race, religion, sex,
sexual orientation, disability or any other factor. Our Diversity Policy demonstrates a commitment to all job
applicants. With this in mind, all stages of the recruitment process will be monitored.
This sheet will be separated from your application form upon receipt and will not be made available to those
involved in the selection process.

Section 12 – Personal details

A. Sex Male Female

B. Age Date of Birth: Age:

C. Ethnic Group a. White b. Mixed

British White and Black Caribbean

Irish White and Black African

Any other White background White and Asian

Please give details:
Any other Mixed background Please give
details:

c. Asian or Asian British d. Black or Black British

Indian Caribbean

Pakistani African

Bangladeshi Any other Black background Please give

details:
Any other Asian background
Please give details:

e. Chinese or other ethnic group

Chinese

Any other, please give details

D. Nationality:

E. Religion Christian Muslim

Hindu Sikh

Jewish Buddhist

Jehovah Witness None

Any Other Religion

F. Sexual Orientation Bisexual Lesbian

Gay Prefer Not to Say

Heterosexual

6|Page
Section 13 - Disability

The Pioneer Academy is committed to ensuring that employees who have a disability are given every possible
assistance in the workplace, and have achieved the ‘Positive about Disabled People’ award, which gives all
disabled applicants who meet the essential criteria in the person specification the opportunity to be interviewed.

What do we mean by a disability?

The Disability Discrimination Act defines disability as ‘a physical or mental impairment with long term, substantial
effects on ability to perform day to day activities.
Examples of Disabilities
The following list of conditions or impairments is given as a guide only and is not meant to be exclusive. We have
provided this list as it may help you to answer the question.
 Hearing, Speech or Visual Impairments – if you wear glasses or contact lenses this is not normally considered a
disability
 Co-ordination, dexterity or mobility e.g. polio, spinal cord injury, back problems, repetitive strain injury
 Mental health e.g. schizophrenia, depression, severe phobias
 Speech Impairment e.g. stammering
 Learning Disabilities e.g. Down’s syndrome
 Other Physical or medical conditions e.g. diabetes, epilepsy, arthritis, cardiovascular conditions, haemophilia,
asthma, cancer, facial disfigurement, sickle cell, dyslexia etc.
Guaranteed Interview Scheme
As part of our commitment to equalities and diversity, we operate two schemes to ensure that candidates are not
prevented from demonstrating their true abilities during the selection exercise.
 The Guaranteed Interview Scheme – we will interview all applicants with a disability who meet the minimum
criteria for the post and consider them on their abilities
We have a commitment to make Reasonable Adjustments to our recruitment and selection processes, where
appropriate, this is to ensure that no candidate, whether or not they have a disability, is unfairly prevented from
demonstrating their true abilities.

Do you consider yourself to be disabled? Yes No

Please state the type of disability you have:

Please give details of any reasonable adjustments you may require:

Section 14 – Advertising monitoring

How did you find out about this vacancy?

Please list which publication or internet site:

I understand that the Declaration in Section 11 applies to this monitoring form as well as the main application
form.

Hand signed: ____________________________________________________ Date: ________________________

7|Page
General Information
The following information is designed to help you complete the application form as effectively as possible. Please contact a
member of the Schools HR Service, if you require assistance in completing the form, or need the form in an alternative format.

The Pioneer follows a policy of Valuing Diversity and has an equality action plan. We understand that our workforce consists of
individuals who are unique and different and by harnessing these differences we will create an environment where every
individual feels valued and encouraged, where talents are recognised, developed and utilised. This will help us meet our
organisational goals.

Please read the job advertisement carefully paying particular attention to the job description and person specification.

You may provide a CV in addition to your application, however you must still fully complete and return the application form and
recruitment monitoring form.

SECTION 1 - Contact Details

 Please complete this section fully.
 If you are currently working please make sure you indicate if you do not wish to be contacted at work.
 Please provide all previous names.

SECTION 2 - Employment Record

 Please complete this section in date order, beginning with your most recent job and listing all work undertaken since leaving
school/college. You must include all previous employment, including periods of voluntary work. Any breaks between
employment or education and employment should be fully explained.
 Please continue with this section on a separate sheet if necessary.

SECTION 3 - Education & Training

 Please complete this section as fully as possible, we will require evidence of your highest and/or relevant qualifications
before confirming an appointment and may check your qualifications with the relevant awarding body.
 Qualifications are not always essential for all posts; you may have undertaken other training that is just as relevant to the
post.
 Please only complete the questions about holding a driving licence if driving is a duty of the post.

SECTION 4 - Experience & Skills

 This is the most important section and must be completed fully.
 During the short-listing process your skills, experience and knowledge will be assessed against the selection criteria outlined
on the person specification.
 It is therefore very important that you address all the areas identified in the person specification and give specific examples
as to how you meet the selection criteria.
 You may have gained relevant experience through paid employment, or voluntary work in the community or in a school
environment, etc…
 You may find it helpful to do a rough draft first making sure you have covered all the requirements of the person
specification.

SECTION 5 - References
 All offers of appointment depend on receiving references satisfactory to the School. You must give two referees that have
had managerial/ supervisory responsibility for you, one of whom must be your manager with your current/most recent
employer.
 If you have not worked for some time or have not worked, give the name of someone who can comment on your ability to
do the job. References will not be accepted from relatives or from people writing solely in the capacity of friends. Further
advice on who is suitable as a referee is available from Schools HR.
 The School reserves the right to ask for substitute referees, if the one you have provided are not deemed to be suitable.
 For certain posts we reserve the right to contact any previous employer for a reference at any time. For posts involving
working with vulnerable adults or children we will specifically enquire about disciplinary offences relating to these groups,
including any which are “time expired”, and whether the applicant has been the subject of child protection concerns, and if
so, the outcome of that enquiry or disciplinary procedure. If you are not currently working with these groups but have done
so in the past, that previous employer will be asked about those issues.

8|Page
SECTION 6 – Declaration of criminal offences
 Posts that involve access to persons who are disabled or addicted to drugs or alcohol or under 18 or over 65 are exempt
under the Rehabilitation of Offenders Act 1974 by virtue of the Exception Order. This post involves access to persons
under 18 and therefore you must reveal details of all convictions spent or otherwise. This post is also subject to a
Disclosure and Barring Service Enhanced Disclosure.

SECTION 7 – Dismissal, disciplinary or capability procedures

 Please provide details on a separate sheet. This will be considered alongside all other information provided in your
application and will not automatically prevent your application progressing further.

SECTION 8 - Asylum and immigration act 1996 - eligibility to WORK

 Please complete this section fully, relevant documentation will be checked for the successful candidate.

SECTION 9 – Declaring an interest

 Failure to disclose an interest will disqualify you from being appointed to a post with The Pioneer Academy.

SECTION 10 – Additional information/special arrangements

 Please provide dates and times when you are not available for interview, plus any additional information we may need to
consider.

SECTION 11 - Declaration
 Please read this section carefully before signing your application form.
 Failure to sign this part of form will disqualify you from being appointed to a post with The Pioneer Academy.

SECTION 12 – Recruitment Monitoring – personal details

 In order to make sure that The Pioneer Academy's policy on Valuing Diversity is working effectively, monitoring information
needs to be collected and analysed. This information is confidential and monitored by Schools HR. It will not be used for
selection purposes.

SECTION 13 – Recruitment monitoring - disability

 The Pioneer Academy is committed to ensuring that employees who have a disability are given every possible assistance in
the workplace, and have achieved the 'Positive about Disabled People' award, which gives all disabled applicants who meet
the essential criteria in the person specification the opportunity to be interviewed.
 If you answer YES to the question and require any special arrangements at interview, please add these to Section 14. You
will be asked at interview stage if you require any adjustments that would assist you at work if you were to be successful.

SECTION 14 - Advertising monitoring

 This information is required to ensure that The Pioneer Academy can monitor the effectiveness of its recruitment
advertising.

CHECKLIST
 Read through your completed application form carefully making sure you have fully answered all the questions.
 If you have completed separate sheets make sure that these are numbered and clearly marked with your name.
 Keep a copy of your application form for reference.
 Make sure you return the application form in plenty of time before the closing date appropriately stamped.

WHAT HAPPENS NEXT

 Your completed application form will be used to decide whether or not you are selected for interview.
 Thank you very much for completing your application and recruitment monitoring form. We appreciate the time and effort
you have taken to complete your form.
 If you have any queries, then please refer to the advertisement for contact details.

9|Page