Employment Application Form

Employment Application Form
Position applied for
Closing date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please complete every section. If a question does not apply, write “Not applicable”. The shortlisting panel will assess the information provided against the requirements of the role.

Before you return the form: check that your employment history is complete, explain any gaps, include two suitable referees in line with section 8, and sign the declaration. You are also required to attach a copy of your highest Early Years Education certificate, along with the modules list associated with that qualification.
1. Personal details
Title
First name(s)
Last name
Former name(s)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postcode
Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email address
example@example.com
Mobile number
Format: (00000) 000-000.
2. Current or most recent employment
Current Employer / Establishment
Employer's Name and Position
Your Job Role
From:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
To:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Notice Period
Reason for leaving
Key duties and responsibilities

3. Employment history
List all previous positions, beginning with the most recent.

Include nursery or school experience and other employment. Continue on a separate sheet if necessary.
Previous Employer / Establishment 1
Employer's Name & Position

Employer's NamePosition in company
Your Job Role
From:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
To:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Reason for leaving
Key duties and responsibilities
Previous Employer / Establishment 2
Employer's Name & Position

First NameLast Name
Post held
Your Job Role
From:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
To:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Reason for leaving
Key duties and responsibilities
Previous Employer / Establishment 3
Manager's Name

First NameLast Name
Post held
From:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
To:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Reason for leaving
Key duties and responsibilities
2

Employment gapsGive dates and a brief explanation for any gaps in your employment history. Please put N/A if there are no gaps
4. Supporting statementExplain why you are applying and how your knowledge, experience, technical skills, personal qualities and behaviours meet the person specification. Address every essential criterion and give specific examples.

5. Qualifications
List qualifications and educational establishments, including all Early Years qualifications. Original certificates will be requested if you are invited to interview.

The first one must be related to your highest early years training/ qualification
Educational Establishment/ Name of School or College
Tutor's Name
Full Title of Qualification in Early Years
Grade Achieved
Start Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
End Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Confirm attachment of certificate and modules list (use drop and drag below)
Upload photo of Highest Early Years Certificate and modules list

Cancelof
Educational Establishment/ Name of School or College
Tutor's Name
Qualification
Grade Achieved
Start Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
End Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Educational Establishment/ Name of School or College
Tutor's Name
Qualification
Grade Achieved
Start Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
End Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Educational Establishment/ Name of School or College
Tutor's Name
Qualification
Grade Achieved
Start Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
End Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Educational Establishment/ Name of School or College
Tutor's Name
Qualification
Grade Achieved
Start Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
End Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

6. Training and professional development
List relevant training completed in the last three years, such as Paediatric First Aid and Safeguarding, and include any relevant professional memberships.

6. Training and professional development

Rows	Course or Membership	Date Achieved	Provider Name	Grade/ Result
1
2
3
4

7. Additional information
This role is subject to the level of Disclosure and Barring Service (DBS) check stated in the job information. Where the duties are regulated activity with children, this will include an enhanced DBS check with a Children's Barred List check. Any appointment is conditional on satisfactory safer-recruitment and suitability checks. You must hold both a current Enhanced DBS and be registered on the Update Service.

If you already hold a DBS certificate registered with the Update Service, you may provide the following optional details:
DBS certificate number:
DBS certificate date (if applicable):

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Registered with the DBS Update Service:
If you do not have both of these you will be required to complete a DBS and join the Update Service before your employment commences. We can assist in this, however full payment is required by the prospective employee.
Criminal-record disclosure

Because this role is eligible for the DBS check described above, you must disclose only convictions, cautions, reprimands or warnings that are not protected under the Rehabilitation of Offenders Act 1974 (Exceptions) Order and current DBS filtering rules. You must not disclose protected matters.
Do you have any relevant criminal-record information that you are legally required to disclose for this role?
If yes, provide brief details below or, if you prefer, submit them separately in a sealed confidential envelope marked for the designated safeguarding lead:
Are you currently subject to any criminal investigation, charge or proceeding that may be relevant to your suitability to work with children?
Are you related to, or in a close relationship with, an existing employee?
If yes, give the person's name, job title and relationship to you:

8. References
As part of our safer recruitment, you are required to provide two referees. One must be your current or most recent employer, training provider or education setting.

Where you have previously worked with children, include your most recent relevant employer. Referees must be authorised senior people in their organisation and must not be family members. Personal or friend references are not accepted.

If your current or most recent employer is not an early-years or childcare setting, include your most recent employer in which you worked with children as the second referee. References will be verified directly with the organisation and should be completed by an authorised senior person.
Referee 1 — current or previous employer
Organisation/ Company
Referee name and position

Full NamePosition in Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone
Format: (00000) 000-000.
Email
example@example.com
Relationship to you
If invited to interview, may we approach this referee without further reference to you?
Required references and suitability checks must be received and assessed as satisfactory before an appointment is confirmed or employment begins.
Referee 2 — most recent nursery employer if Referee 1 is not
Organisation/ Company
Referee name and position

Full NamePosition in Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone
Format: (00000) 000-000.
Email
example@example.com
Relationship to you
This referee will be contacted directly.
Required references and suitability checks must be received and assessed as satisfactory before an appointment is confirmed or employment begins.

9. Declaration
I declare that, to the best of my knowledge, I am not barred from regulated activity with children and am not included in the Disclosure and Barring Service Children's Barred List. I also declare that I am not disqualified from providing, managing or being employed in relevant childcare under the Childcare Act 2006 and applicable regulations, unless a waiver has been granted and disclosed to Merry Go Round. I will notify Merry Go Round promptly if any information relevant to my suitability to work with children changes.

I certify that the information given in this application is complete and true to the best of my knowledge. I understand that any appointment is conditional on satisfactory pre-employment checks and that materially false or omitted information may result in withdrawal of an offer or disciplinary action, up to and including dismissal, subject to applicable law and procedure.
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Print name

First NameLast Name
10. Data protection and equal opportunities
Recruitment privacy notice. Merry Go Round will use the information in this form to administer recruitment, assess suitability, complete pre-employment checks, meet safeguarding and legal obligations, and establish an employment relationship where applicable. Processing will rely on appropriate lawful bases under UK data-protection law, which may include taking steps before entering into a contract, compliance with legal obligations and legitimate interests. Special-category and criminal-offence information will be processed only where an additional lawful condition applies. Information may be shared only with people involved in recruitment, referees, relevant vetting or regulatory bodies, professional advisers and service providers where necessary and lawful.

Recruitment records will be kept securely only for the periods stated in Merry Go Round's recruitment privacy notice and retention schedule, then securely deleted or destroyed unless a longer period is required by law. Applicants may request access to their information, correction of inaccurate information, restriction or objection where applicable, and may complain to the Information Commissioner's Office. Requests and privacy enquiries should be sent to merrygoround@btconnect.com. The full privacy notice, including retention periods and the identity and contact details of the data controller, should be provided with this form.

The separate, voluntary equal opportunities monitoring form is used only to monitor recruitment practices. It will be kept separate from this application and will not be made available to the shortlisting or interview panel.

Reasonable adjustments. If you need a reasonable adjustment to take part in any stage of the recruitment process, contact Merry Go Round on 01432 352016 or at merrygoround@btconnect.com. You do not need to provide general medical information on this application form.
Return your application

Paper applications	Mrs N Ovel Merry Go Round Green Croft Children's Centre Green Croft Hereford HR2 7NT
Electronic applications	Processed via JotForm
Contact telephone	01432 352016
Contact email	merrygoround@btconnect.com

Thank you for your application.
Should be Empty:

Employment Application Form

1. Personal details

2. Current or most recent employment

3. Employment history

5. Qualifications

6. Training and professional development

7. Additional information

8. References

Referee 1 — current or previous employer

Referee 2 — most recent nursery employer if Referee 1 is not

9. Declaration

10. Data protection and equal opportunities

Return your application