[email protected].

uk

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be One in a million

job application form

Birmingham City Council is committed to equal opportunities in employment
and we positively welcome your application irrespective of your gender, race, FOR OFFICE USE
disability, colour, ethnic or national origin, nationality, sexuality, gender Job ref no: IT
identity, marital status, responsibility for dependants, religion, trade union Date sent out:
activity and age. Date returned:

Please complete all sections on the form. If any section does not Application no:

apply to you, enter not applicable (n/a). It is important that you Closing Date:

refer to the Guidance Notes before completing this form. Electronic

versions of this form are available at www.birmingham.gov.uk/jobs
This form is also available in large print, Braille or on audio tape on
request.
1. Vacancy Details This section must be completed
Job title:       Directorate:       Service Area:      

2. Personal Details
First name(s):       Last name:       Former name(s):      

Address: Title: e.g. (Mr,Mrs,Ms):      

      Postcode:      

Daytime tel no:       Evening tel no:      

Mobile tel no:       Email:      

Please indicate if you are happy to receive correspondence

via your email address e.g. invite to interview letter Yes No

National Insurance Number, if you have one                  

Current driving licence (if this is a requirement of this job): Yes No

If YES, type of licence

3. General Information 4. Arrangements for interview

a) Are you related to a Councillor or employee If you have a disability, are there any arrangements which
of Birmingham City Council? Yes No we can make for you if you are called for an interview
and/or work based exercise? Yes No
If yes, please provide details:
If yes, please specify, (e.g. ground floor venue, sign
Name:       language interpreter, audio tapes etc).

Position:            

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Relationship:            

Directorate:      

b) Do you wish to job share the job you are applying for? Yes No

5. Education/Qualifications (including overseas) Please start with secondary education.

To From Secondary School/ Examinations taken Results Date

mth yr mth yr College/University etc or to be taken & grades gained

                                           

                                           

                                           

                                           

                                           

                                           

                                           

6. Training Please list any course(s) which you have undertaken which are relevant to the job and/or
specified on the person specification.

Year Organising body Course title Length

                      

                      

                      

                      

                      

                      

                      

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Please continue on a separate sheet if necessary.

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7. Membership Please indicate membership of any organisation(s) relevant to this job.

Name of organisation Type of membership Date of membership

                 

                 

                 

                 

                 

8. Past Employment & Experience (if any) include voluntary or other relevant experience.

To From Employer Job Title Reason for change

mth yr mth yr

                                     

                                     

                                     

                                     

                                     

                                     

                                     

                                     

                                     

                                     

Please continue on a separate sheet if necessary.

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9. Present or Most Recent Employment (if any)

Job title:       Employer:      

Salary:      

Date Started:       Date left (if applicable):      

Address:      

      Postcode:      

Reason(s) for leaving (if applicable):      

10. Ill Health Retirement/Dismissal

Have you ever taken ill health retirement from Birmingham City Council or been dismissed for some other reason?
Yes No
If yes, please give the date and department/directorate:      

     

11. References Please give details of two referees one of which must be your current or most recent line
manager/supervisor, or other person designated within the organisation to provide references.

Please put a cross in the appropriate box(es) below if you do not wish us to take up a reference without
your consent.

Name:      

Address:      

      Postcode:      

Tel no:       Email:      

Job title:       Relationship to you:      

If this referee knows you by another name please give that

name:

Name:      

Address:      

      Postcode:      

Tel no:       Email:      

Job title:       Relationship to you:      

If this referee knows you by another name please give that name:

Please note some jobs may require a Criminal Records Bureau Check, further information regarding this will be
contained in the application pack, if applicable.

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12. Other information in Support of your Application
In order for us to decide whether to call you for interview, it is essential that you provide us with sufficient details of any
experience and skills which demonstrate how you meet the requirements of this job, as set out in the person
specification. Please continue opposite. You may also continue on a separate sheet(s) if you wish. You should
ensure that any additional sheets are attached securely and include your name and job reference number / job title.
It is important that you refer to the ‘Guidance Notes’ when completing this section.

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13. Data Protection Act 1998 - Consent and Certification of Details
The information detailed in this application form may be used by Birmingham City Council in the monitoring and
progression of its employment policies and practices, and in particular its Equal Opportunities in Employment Policy.
This monitoring is for statistical purposes only and you will not be identifiable from this process. However, your
personal details contained in the application form may be used in the prevention and detection of fraud. Where this
occurs you will be identifiable. The information may be disclosed to the following third parties:
• Survey and research organisations (for monitoring purposes only).
• Local Government Authorities
• Central Government Authorities
• Organisations that handle or investigate the proper use of public funds
• Law Enforcement Authorities
Application forms of unsuccessful candidates will be destroyed after six months following an appointment to the job.
Giving false information will result in your application not being pursued or your contract being terminated if you have
already been appointment to the job.

I, (print name):      

Consent to Birmingham City Council recording and processing the information detailed in this application form. I
understand that this information may be used by the City Council in pursuance of its business purposes and my
consent is conditional upon the City Council complying with their obligations under the Data Protection Act 1998.

I also confirm that the information contained in this application form is correct.

Signature:       Date:      

If you are making your application in Braille or on audio tape you must declare that you have read and
understood this section and that the information you have given is true and correct at the time of completion.
You may also be required to sign a declaration to this effect at a later date.

www.birmingham.gov.uk/jobs Application forms not fully completed may be refused.

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Page 8 of 12
Recruitment Monitoring
Name:       Gender

Job title:       I am: Female Male

Job ref no:       Date of Birth:       Age:      

To help us monitor our Equal Opportunities in Disability

Employment Policy please tick or complete the
following boxes as appropriate: The Disability Discrimination Act 1995 defines a person as
having a disability if he/she has a physical or mental
Ethnic Origin impairment which has a substantial and long term adverse
effect on his/her ability to carry out normal day to day
Choose one section from (A) to (E) then tick the activities.
appropriate box to indicate your cultural background. Do you have a disability as defined above? Yes No
These are based on the 2001 Census with additional
categories included. If all of the above does not apply to you, however, you
consider yourself to have a disability, please tick here.
A White
Employment Status
British Albanian/Kosovan Roma
Irish Bosnian Are you currently employed by Birmingham City Council?
Yes No
Any other White background please write in below: If yes, please state if you are employed on a temporary,
casual or permanent basis:

B Mixed Are you currently unemployed? Yes No

White and Black - Caribbean Job Advertisement

White and Asian
White and Black - African How did you first find out about this job? Please specify
Asian and Black the source or publication.

Any other Mixed background please write in below: Forward

Birmingham Evening Mail

C Asian or Asian British
Other Newspaper (please specify),
Indian Kashmiri Pakistani Bangladeshi
Professional Journal (please specify),
Any other Asian background please write in below:
Radio (please specify),

D Black or Black British Birmingham City Council Website

Caribbean African Jobsgopublic Website

Any other Black background please write in below: Website, other (please specify),

Word of Mouth
E Chinese or other ethnic group
Careers/open day (please specify),
Chinese Arab Afghan
Kurdish Vietnamese Jobcentre Plus

Search Consultant
Any other please write in below:
Other (please specify),

Updated: Ma
Page 9 of 12
Birmingham City Council, the largest council in the country, Section 2: personal details
employs around 50,000 people in a number of directorates which Please enter your personal details fully and clearly so that
provide a vast range of key services to the citizens of we may contact you about your application.
Birmingham.
We only need to know if you have a driving licence if this
The City Council has an Equal Opportunities in Employment is a requirement of the job.
Policy. This means that we welcome your application irrespective
of your gender, race, disability, colour, ethnic or national origin, If you do not currently have an National Insurance
nationality, sexuality, gender identity, marital status, responsibility Number, please leave this blank.
for dependants, religion, trade union activity and age. One of the
City Council’s main aims is that all levels of its workforce should Section 3: general information
reflect the City’s population and that everyone seeking jobs and If you are related to a Councillor or an employee of the
promotion within the City Council has an equal chance. Some of City Council we ask you to tell us so that we can make
the ways in which we do this are by: sure all applications are treated fairly. Canvassing any
Councillor or employee of the City Council (i.e. seeking to
• advertising jobs widely to enable all sections of the gain an unfair advantage through personal contacts) will
community access to our jobs; disqualify your application.

• making sure that we only ask for particular As part of the City Council’s Equal Opportunity in Employment
qualifications or experience if they are essential. Policy most of the City Council’s vacancies are open to job
sharing. This normally means that two people can voluntarily
The Equal Opportunities and Employment Policy is here to share one full time job.
ensure that both present and future employees are
treated fairly. If you become a Birmingham City Council They share the pay and other benefits in line with the
employee, you will in turn be obliged to follow this policy. hours worked; the split need not be 50/50. It is not
necessary to apply with a partner. If you would like to job
The application form share the job you are applying for, please tick the relevant
Completing the application form is the first step in the box. Further information is available from the Human
recruitment process which may lead to an interview and Resources Section in the directorate concerned.
the possible offer of a job. It is therefore most important
that you complete ALL sections of the application form Section 4: arrangements for interview
which are relevant to you as clearly and fully as possible. If you have a disability, please complete this section so
If you are unable to complete the form, you may ask that we can make suitable arrangements if you are called
someone to do it on your behalf. If you have a disability for an interview and/or a work based exercise.
and would prefer to submit your application on tape or in
another format – you may do so. Your recording should Section 5: education/qualifications
follow the format of the application form. We are interested in any form of education you have
followed, including any courses which did not lead to an
Criminal records bureau (CRB) disclosures examination or qualification. We will take full note of any
For posts where there is contact with, or access to education or qualifications gained overseas or as part of
personal records relating to children, young people and an employment training scheme. Successful candidates
vulnerable adults, a CRB Disclosure will be required. The will be required to provide proof of qualifications.
Rehabilitation of Offenders Act 1974 (exceptions) Order
1975 does not allow employees with access to children, Section 6: training
young persons under the age of 18 and vulnerable adults Please include any training gained through work or other
the right to withhold information regarding previous activities, which you feel, is relevant to the job you are
criminal convictions, cautions and bindovers, including applying for.
those regarded as 'spent' - all must be declared. You
should be aware that we have a policy on the recruitment Section 7: membership
of ex-offenders, and a copy is available on request. A This section refers to membership of institutes or
criminal record will not necessarily be a bar to obtaining a organisations relevant to the job you are applying for,
position. such as Professional, Occupational or Trade Membership.

Section 1: vacancy details

This section may have already been completed by Contact
Birmingham, but please check that all the details are complete
and correct. If they are not included please refer to the job
advertisement to fill in this section.

be One in a million

guidance notes

Page 10 of 12
Sections 8 & 9: past & present, or most recent Section 12: other information in support of you’re
employment application
We require information on past or present employment. If you When completing this section you can mention any
have recently left school or college, or a training programme and experience gained through work, school, college, at home,
have not yet had a full-time or permanent job, please give details in voluntary work, on work experience or through hobbies.
of any other employment that you may have had such as work Think about how you can draw upon your skills and
experience, part-time, holiday work or voluntary work. experience, and then match these against the criteria set
out on the person specification. You should avoid bland
Section 10: retirement/dismissal statements such as “I have all the skills and abilities
Please ensure you tick the appropriate box. mentioned in the person specification” and fully explain
how you meet the requirements e.g. if the person
Recruitment monitoring specification asks for “experience of working with elderly
All applicants are requested to complete this section including people”, you need to explain when, where and what was
those that submit a CV. involved, e.g. “I helped to care for my grandmother for 3
years. She lived in the family home and I helped her to
You are asked to complete this section to enable us to wash and dress each morning. I also helped with personal
monitor the effectiveness of our Equal Opportunity in care including…”
Employment Policy. To do this we need to know:
• your ethnic origin For Section 12 only, you may enclose a Curriculum Vitae
• whether you are male or female (CV). You should ensure it contains sufficient information
• your age to assess whether you possess the essential requirements
• whether you have a disability for the job when the selection panel is shortlisting. Should
• your employment status you choose to provide a CV for this section you must
complete all other sections on the application form.
Please help us by ticking or completing the appropriate
boxes in this section. Any information gathered will not Section 13: data protection act 1998
identify individuals, but will only be used to measure how Please make sure that you have signed and dated the
we are progressing. Some of the information may also be application form to confirm that your details are correct
used because we have a policy of guaranteeing an and complete. The falsification of information on the form
interview to people with disabilities who meet the will result in the application not being pursued or your
essential requirements of the job. contract being terminated if you have already been
appointed.
Section 11 : references
References will be taken up before appointment. In any What happens next?
instance the references will only be considered once After the closing date, shortlisting will be conducted by a
interviews have taken place to support the Selection Panel, who will match your skills/experience(s) against the
Panel’s decision. Please give the names and addresses of criteria in the Person Specification.
two referees. If you are employed or have been employed
in the past, the first referee should be your present or If you meet all the essential criteria for the job and have a
most recent line manager/supervisor or other person in disability you will be guaranteed progression to the next
your organisation designated to provide references. stage of the selection process. The selection process may
involve an interview(s), a short presentation or other
For jobs where you will be responsible for money or stock work-based exercise.
including Computer Systems Analysts and Programmers,
you must ensure you provide details of former employers The Person Specification indicates how the criteria will be
to cover the last twelve months. If you are unable to assessed, e.g. ‘AF’ = application form, ‘I’ = interview, ‘T’
provide an employer reference for reason of = test, ‘P’ = presentation and ‘E’ = exercise.
unemployment or where your employer no longer exists,
you are asked to name referees who are able to verify You will be selected for interview entirely on the contents
your good character. School or college leavers should of your application form, so please read the Job
give a Head Teacher or their college principal as the first Description and Person Specification carefully before you
referee. “Job Title” (if applicable) refers to the referee, complete your form.
e.g. Manager, Head Teacher. “Relationship to you” refers
to how they know you, e.g. immediate supervisor, Each application is given equal consideration. The
neighbour etc. If you have changed your name, e.g. by selection panel treats all applicants fairly and makes no
marriage or deed poll or are known by a nickname, please assumptions about you. We look at what you tell us about
indicate the name that your referee(s) know(s) you by. yourself on the application form.

In the interest of economy we only acknowledge receipt of

your application if you include a stamped addressed
envelope.

We look forward to receiving your application.

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 be One in a million

y 07

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