Application for Post of Site Supervisor The CE Academy County Office

Cromwell CampusPoole Street

NorthamptonNN1 3EX

t. 01604 239734

f. 01604 626950

POSTPersonal detailsLEGAL SURNAME(including preferred title)

LEGAL FORENAME

PREFERRED SURNAME

PREFERRED FORENAME(S)

ADDRESS(including postcode)

TELEPHONE NO(including STD code)

NI Number

MOBILE NO DATE OF BIRTH

EMAIL ADDRESS

Present employment

Name and address of employer

Job title

Date commenced

Salary/hourly rate

Nature of business

Notice required

Version 1/Date: 24-Jul-14

The CE Academy - Application for Post of Site Supervisor

Previous employment (most recent first)

Employer Job title Salary Commenced(dd/mm/yy)

Completed(dd/mm/yy) Reason for leaving

Education, Qualifications and TrainingSchool, college and university leavers should indicate those examination results awaitedSecondary School/College/University/Institute attended Qualifications gained/non qualification courses Level Grade

(If app) Year

Membership of Professional Bodies Grade Date from

Additional Qualifications (eg Swimming Awards, Music Certificates, Coaching Awards)

Personal interests/leisure activities

The CE Academy - Application for Post of Site Supervisor

Certain restrictions apply to the appointment to The CE Academy of persons who are closely related to existing members of staff. Are you closely related to any person(s) employed in The CE Academy? If so, please indicate the name and position of the person(s) in question

This appointment is excluded from the non-disclosure provisions under the Rehabilitation of Offender Act 1974. Applicants must declare any convictions which for other purposes are “spent” and in the event of employment, failure to disclose such convictions could result in dismissal or disciplinary action by The CE Academy. Any information will be treated confidentially.Have you ever been convicted of a criminal offence by a Court of Law? If yes, please attach details including the offence and the date. (X as appropriate)

YES NO

Letter of applicationThis form should be accompanied by a separate letter of application to include a summary of your experience and other information in support of your application.

Referees (one should be your present/last employer)1st Referee 2nd Referee

Title/NameStatusAddress

Tel No (inc STD)Fax No (inc STD)Email

DECLARATIONI declare that all information provided by me as part of this application is true and complete to the best of my knowledge and belief. I understand that either withholding or giving false information will disqualify my application or if discovered after appointment, may be regarded as grounds for dismissal.

I understand that, if offered this post, the appointment will be subject to a DBS, medical clearance and employment references, all of which are satisfactory to The CE Academy.

Signed Date

Any offer of appointment is subject to satisfactory Health and DBS (Disclosure and Barring Service) Enhanced Disclosure Check