Application Form

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The information given on this form will be treated in confidence. Any offer of employment will be subject to satisfactory medical clearance and Disclosure & Barring Service (DBS) checks and the production of documentary evidence showing your entitlement to work in the UK. As part of our safer recruitment process an online search will be carried out at the time of application.

So that we compare candidates fairly, this form is the only document we consider when screening applications. Therefore, please do not send a CV, written references, examples of work or other supporting information unless it is specifically requested.

Position Details

Position Applied For(Required)

Personal Details

Title

Forename(Required)

Surname(Required)

Previous Name(s)

Current Address(Required)

Previous Address

Complete if you have lived at your current address for less than five years

Email Address(Required)

Phone Number(Required)

National Insurance Number(Required)

Education and Qualifications – Secondary and Further Education

Please give details of your Secondary and Further Education

Secondary/Further Ed – School / College / Institution (Full Name and Address)

Secondary/Further Ed – Qualifications, Grades, Date Awards Made and Awarding Body

Secondary/Further Ed – Dates From (mm/yy)

Secondary/Further Ed – Dates To (mm/yy)

Education and Qualifications – Higher Education

Please give details of your higher education or equivalent course

Higher Ed – College / Institution (Full Name and Address)

Higher Ed – Qualifications, Grades, Date Awards Made and Awarding Body

Higher Ed – Dates From (mm/yy)

Higher Ed – Dates To (mm/yy)

Other Qualifications or Relevant Training

Please give details of any other professional or vocational qualifications or training relevant to this post (e.g. Paediatric First Aid, food safety and hygiene, SEND)

Other Qualifications – Qualifications Obtained and Grade / Level

Other Qualifications – Name of Awarding Body or Training Provider

Other Qualifications – Date Obtained (mm/yy)

Employment History – Current or Most Recent Employment

Please supply a full history of all employment, self-employment and any periods of unemployment since leaving secondary education, in reverse date order. Include voluntary work.

Current Employment – Job Title

Current Employment – Employer

Current Employment – Employer Address

Current Employment – Employed From (mm/yy)

Current Employment – Employed To (mm/yy)

Current Employment – Reason for Leaving

Current Employment – Salary and Hours

Current Employment – Brief Description of Roles and Responsibilities

Previous Employment History

List all previous employment in reverse date order. Include voluntary work and self-employment.

Previous Employment 1 – From (mm/yy)

Previous Employment 1 – To (mm/yy)

Previous Employment 1 – Name and Address of Employer

Previous Employment 1 – Job Title and Brief Description of Duties

Previous Employment 1 – Reason for Leaving

Previous Employment 2 – From (mm/yy)

Previous Employment 2 – To (mm/yy)

Previous Employment 2 – Name and Address of Employer

Previous Employment 2 – Job Title and Brief Description of Duties

Previous Employment 2 – Reason for Leaving

Previous Employment 3 – From (mm/yy)

Previous Employment 3 – To (mm/yy)

Previous Employment 3 – Name and Address of Employer

Previous Employment 3 – Job Title and Brief Description of Duties

Previous Employment 3 – Reason for Leaving

Previous Employment 4 – From (mm/yy)

Previous Employment 4 – To (mm/yy)

Previous Employment 4 – Name and Address of Employer

Previous Employment 4 – Job Title and Brief Description of Duties

Previous Employment 4 – Reason for Leaving

Gaps in Employment

Please give details of any gaps in your employment since leaving secondary/further education

Employment Gap – From (mm/yy)

Employment Gap – To (mm/yy)

Employment Gap – Details of Gap

Personal Statement

Supporting Statement(Required)

Please provide a statement that introduces you, highlights your relevant experience, values, and career goals, and explains why you are a strong candidate for the role referencing the person specification and job description.

Recent Early Years Experience(Required)

Please provide details of your most recent experience in early years childcare, what this included, and your commitment to working with children.

Child Protection Experience(Required)

What experience do you have of dealing with child protection concerns and what procedures did you follow?

References

Please provide two referees. We will contact these referees if you are shortlisted and seek references before interview. One referee must be your current or most recent employer.

Reference 1 – Name(Required)

Reference 1 – Position(Required)

Reference 1 – In What Capacity Do You Know the Referee?(Required)

Reference 1 – Name of Organisation(Required)

Reference 1 – Address(Required)

Reference 1 – Telephone(Required)

Reference 1 – Email(Required)

Reference 2 – Name(Required)

Reference 2 – Position(Required)

Reference 2 – In What Capacity Do You Know the Referee?(Required)

Reference 2 – Name of Organisation(Required)

Reference 2 – Address(Required)

Reference 2 – Telephone(Required)

Reference 2 – Email(Required)

Health and Disability Details

Do you have a disability for which reasonable adjustments may be required to enable you to attend an interview?(Required)

Yes

'Disability' is defined as a physical or mental impairment which has a substantial and long-term effect on a person's ability to carry out normal day-to-day activities.

If Yes – Please give brief details of your disability and adjustments required

Conduct Declarations

Have you ever been dismissed for misconduct from any employment, volunteering, office, or other position previously held by you?(Required)

Yes

Have you left any employment or volunteering prior to a misconduct outcome, or been dismissed at the end of probation?(Required)

Yes

If Yes to either above – Please give details

Have you ever been under investigation for or subject to any disciplinary sanctions in relation to your conduct at the time of your dismissal/leaving any employment, volunteering, office, or other position previously held by you?(Required)

Yes

N/A

If Yes – Please give details (disciplinary sanctions)

Have you ever been the subject of a safeguarding investigation/concern?(Required)

Yes

Did the outcome of any safeguarding investigation/concern result in any of the following: a) Referral to professional body (DBS) b) Referral to Children's Services and/or LADO c) Referral to police(Required)

Yes

If Yes – Please give details (safeguarding outcome)

Have you ever been subject to any sanctions being placed on your professional registration by a regulatory or licensing body in any country?(Required)

Yes

Sanctions may include warnings, conditions, limitations, suspension, removal or any other restrictions that have applied to your professional registration.

If Yes – Please give details of sanctions and name and address of the regulatory or licensing body

Other Declarations

Right to Work – Please confirm that you will provide proof of your right to work in the UK as part of any selection process.(Required)

Yes, I confirm I will provide proof

To comply with Asylum and Immigration legislation, proof of right to work in the UK is required.

Working Time Directive – Do you plan to undertake work for other employers which would cause a breach of the 48-hour working week regulations?(Required)

Yes

Under the Working Time Directive, you should not work more than 48 hours a week.

If Yes – Please provide details (Working Time Directive)

Do you have a criminal record? Failure to disclose this information could result in dismissal or disciplinary action.(Required)

Yes

I confirm that I have not been barred from working with children by the Disclosure and Barring Service(Required)

Yes, I confirm this

Have you been cautioned (on or after 6 April 2007) or convicted (at any time) of any offences against a child?(Required)

Yes

Have you been subject to any order relating to the care of children?(Required)

Yes

Rehabilitation of Offenders Act 1974

This post involves working in Regulated Activity under the Safeguarding Vulnerable Groups Act 2006 and is subject to an enhanced DBS with barred list check. It is a criminal offence to apply for or accept a position working with children if you have been barred from engaging in regulated activity. This post is exempt from the Rehabilitation of Offenders Act 1974 and shortlisted candidates will be asked to provide details of all unspent convictions and those that would not be filtered, prior to the date of the interview. If your application is successful, this self-disclosure information will be checked against information from the Disclosure & Barring Service before your appointment is confirmed.

Declaration

I agree that any offer of employment with Apollo Day Nursery is subject to satisfactory evidence of the right to work in the UK, satisfactory references, DBS check and other pre-employment vetting checks. In accordance with the Data Protection Act (2018), Apollo Day Nursery will hold and use my personal information for personnel reasons. I confirm that the information given in this application is factually correct and complete and I understand that any false information may, in the event of employment, result in dismissal or disciplinary action by Apollo Day Nursery.

Print Name(Required)

Date(Required)

MM slash DD slash YYYY

Declaration Agreement(Required)

I confirm that the information provided in this application is true and complete to the best of my knowledge.