Internal use only

Reference no:

Date received:

Employment Application Form: Support

We are committed to safeguarding and promoting the welfare of children and young people and expect all staff and
volunteers to share this commitment.

Please ensure that you complete all sections of Part 1 and Part 2 of the application. Please note that providing false
information will result in the application being rejected, withdrawal of any offer of employment, summary dismissal if you
are in post, and possible referral to the police. Please note that checks may be carried out to verify the contents of your
application form. Please complete the form in black ink or type. CVs are not accepted.

Vacancy job title: Assistant Head of Year non-teaching

Part 1: Information for Shortlisting and Interviewing

Initials AB Surname or Family Name Blake

1. Letter of Application
Please enclose a letter of application. Please refer to the applicant information pack which may include instructions on
how to complete the letter of application.

2. Current/Most Recent Employment:

Name and address of employer: Little Sprouts Childcare 5 Kempton Crescent (Self Employed)

Job title:
Please enclose a copy of the job description, if Nanny / Childminder
possible

Date appointed to current post: January 2020

Current salary:

Date available to begin new job: Negotiable

March 2018
3. Full Chronological History
Please provide a full history in date order, most recent first, since leaving secondary education, including periods of any
post-secondary education/training, and part-time and voluntary work as well as full time employment, with start and
end dates, explanations for periods not in employment or education/training, and reasons for leaving employment.

Number on Dates (DD/MM/YYYY)

Name and address of school,
Job title or roll and type Full or Reason for
other employer, or description From To
positon of school, if part-time leaving
of activity
applicable
Little
Sprouts
Childcare Looking after children and Full Jan On going Not enough
(Self creating memories and Time 2020 work due to
Employed)) experiences covid

Hays
(Agency)
Temporary Staff in nurseries Part Aug 23/03/2020 Covid
and primary schools Time 2019 Ended it

(Tree Tops
Montessori Room Deputy Supervisor , Full time Sept 02/08/2019 Needed a
) Running a room , making 2016 new
Room sure the children are happy challenge
Supervisor and safe as well as managing
staff

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 Please enclose a continuation sheet if necessary.

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4. Secondary Education and Qualifications (e.g. GCSE)

Examination passed (i.e. A Level,

Name of school/college From To
GCSE), subject and grade

Sport Science Distinction Star -BTEC

Drama B

English D (Resat in 2018 passed with 5)

Maths
C

C
Science

Pass
IT

D
RE

D
French

G
History

Singing Qualification

Brownie Leader

Assistant Trampolining Coach

Qualification in Flute

March 2018
5. Further or Higher Education
Please provide details of any recognised qualifications or courses attended which are relevant to the job application.

Name of FE college, Dates

Full or part-time Qualifications obtained
university or awarding body From To

CWT 2016 2018 Full time Level 2 & 3 Childcare

course through an apprenticeship

Online Course
Speech Therapist On Going
Qualification 2020 On Going

March 2018
6. Other Relevant Experience, Interests and Skills

Since I have been working with children & young adults for over 6 years this has given me the opportunity to
support many of them, some of which have had physical and learning difficulties. This has allowed me to learn
different teaching methods and approaches. For instance, rewording the question or task, taking another
approach to the situation and also leaving the situation to allow the individual to calm down before trying
again. Whilst listening to what they have to say and come up with a solution together. I am able to help the
young adults to stay focused on their work by using positive praise, giving them time to try answer the
question themselves by letting them work through it independently, I then support them if they require it.
Working 1:1 with a young adult or small groups aids me build a professional relationship with them which
will help me learn what learning techniques will help them progress with their learning. I have worked with
lots of different cultural and family backgrounds and children/young adults with allergies, learning difficulties
and physical impairment.

Speaking to parents or guardians is also something you have to do when working with young adults so taking
a professional and confident approach is needed at all times.

I am a cheerful, confident, independent and a hardworking individual, however I am not afraid to ask for help
and support. I am also good at working in a team, listening to other people’s ideas and offering my own ideas
to a group.

Outside of work I am also an Assistant Trampolining Coach, this job allows me to help children and young
adults to learn new techniques and skills from trampolining skills to life skills, for example: by letting them
face fears and try something new by allowing them take supervised risks. For many years I attended my local
Brownie Pack when I left I was a qualified Brownie Leader. Being a leader gave me the opportunity to
support young girls with finding what qualities they have young lady’s and helping them to learn life and
social skills.

Another reason why I believe I’m suited to the role is due to my experience and qualifications, ability to learn
new techniques as well as work ethics. I have completed my level 2&3 NVQ in childcare, whilst being an
apprentice at Tree tops Montessori nursery. From completing my qualification this led me on to get a job as a
deputy supervisor. Working in a Montessori nursery this has equipped me with different teaching techniques.
Such as learning through the environment, play, experiences, and open-ended questions.

To broaden my knowledge, I have independently enrolled myself in a level 3 speech & language therapy
course. This will provide me with lots of different ways and techniques that I will use to help support children
and young adults in their education. Another teaching technique I have learnt whilst working in child
education is Makaton. Allowing to understand communication through a different language technique is so
crucial and allows the individual to feel important and understood. I will of course share what I have learnt
with others, to allow them to use the techniques with their children.

March 2018
7. Referees
Please provide details of two people to whom reference may be made. The first referee should normally be your present
or most recent Headteacher or equivalent person. If you are not currently working with children please provide a referee
from your most recent employment involving children. Referees will be asked about all disciplinary offences which
may include those where the penalty is “time expired” if related to children. Referees will also be asked whether you
have been the subject of any child protection concerns, and if so, the outcome of any enquiry. References will not be
accepted from relatives or from people writing solely in the capacity of friends.

It is normal practice to take up references on shortlisted candidates prior to interview. This is in line with the most
recent version of Keeping Children Safe in Education statutory guidance.

First Referee

Title and name: Paul Gilligan

Corner Cottage, School Hill, Off Church, CV33 9AL

Address and postcode:

Telephone number: 07958743236

Email address: [email protected]

Job title: Nanny

Relationship to applicant: Nanny

I consent to this reference being requested before interview.

Yes x No

Second Referee

Title and name: Georgina Blackwell

Beech Hurst
21, Stoke Green
Address and postcode:
Coventry
CV3 1FP

Telephone number: 07793 464930

Email address: [email protected]

Job title: Trampolining Coach

Relationship to applicant: Trampolining Coach

I consent to this reference being requested before interview.

Yes x No

March 2018
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March 2018
Part 2 Internal Ref. No.

This section will be separated from Part 1 on receipt. Relevant responses may be verified prior to shortlisting and/or used
for administration purposes but will not then be used for selection purposes.

8. Personal Information

1. Surname or family name: Blake

2. Forenames: Annie
3. Title: Miss

4. Current address: 5 Kempton Crescent

Lillington
Leamington Spa
Warwickshire
5. Postcode: CV32 7TS
6. Home telephone number: 01926 711094
7. Mobile telephone number: 07946475231
8. Email address: [email protected]
9. Do you have a current full clean driving licence? Yes No N/A
Only applicable for posts that require driving
Yes No
10. Do you require sponsorship (previously a work
permit)?
If YES please provide details under separate cover.

9. Compulsory Declaration of any Convictions, Cautions or Reprimands, Warnings or Bind-overs

It is the School’s policy to require all applicants for employment to disclose any previous ‘unspent’ criminal
convictions and any cautions which have not expired, or any pending prosecutions. In addition, the job you are
applying for is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (exceptions order 1975) which
requires you to disclose all spent convictions and cautions except those which are ‘protected’ under Police Act 1997 –
Part V and the amendments to the Exceptions Order 1975 (2013) and are not subject to disclosure to employers on
DBS certificates and cannot be taken into account. Guidance on the filtering of “protected” cautions and convictions
which do not need to be disclosed by a job applicant can be found on the Disclosure and Barring Service website.

If you are invited to interview you will be required to complete a “Disclosure of Criminal Record” form and bring the
completed form to interview. If the job involves contact with children up to age 8 you will also be required to make a
Disqualification Declaration. The information you give will be treated as strictly confidential. Disclosure of a
conviction, caution, bind-over order, warning or reprimand will not automatically disqualify you from consideration.
Any offence will only be taken into consideration if it is one which would make you unsuitable for the type of work
you are applying for. However, offences relating to children may make you unsuitable since this is a “regulated
position” under the Criminal Justice & Courts Services Act 2000.

March 2018
10.Data Protection
The information collected on this form will be used in compliance with Data Protection regulations. By supplying
information, you are giving your consent, if appointed, to the information being processed for all employment purposes
as defined by statute. The information may be disclosed, as appropriate, to the governors, to Occupational Health, to the
Teachers Pensions Agency, to the Department for Education, to pension, payroll and personnel providers and relevant
statutory bodies. This form will be kept strictly confidential but may be photocopied and may be transmitted
electronically for use by those entitled to see the information as part of the recruitment process. When the recruitment
process is completed, your form will be stored securely for a maximum of six months then securely destroyed, unless
you are employed as a result of this recruitment process in which case this application form will be retained as part of
your personnel record.

11.Notes
(a) Under the Criminal Justice & Courts Services Act 2000 it is an offence for an individual who has been
disqualified from working with children to knowingly apply for, offer to do, accept, or do any work in a
‘regulated position’. The position you are applying for is a “regulated position”.

(b) Canvassing, directly or indirectly, an employee or governor will disqualify the application.

(c) Candidates recommended for appointment will be required to provide a satisfactory Enhanced DBS certificate
and complete a pre-employment medical questionnaire and may be required to undergo a medical examination.

(d) This organisation is under a duty to protect the public funds it administers, and to this end may use the
information you may provide as part of the recruitment process for the prevention and detection of fraud. It
may also share this information with statutory bodies responsible for auditing or administering public funds for
these purposes.

12.Declaration
I certify that, to the best of my knowledge and belief, all particulars included in my application are correct. I understand
and accept that providing false information will result in my application being rejected or withdrawal of any offer of
employment, or summary dismissal if I am in post, and possible referral to the police. I understand and accept that the
information I have provided may be used in accordance with paragraph 10 above, and in particular that checks may be
carried out to verify the contents of my application form.

Signature of Applicant: annieblake

Print Name: ANNIEBLAKE

Date: 14/01/2021

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Part 3: Equality and Diversity Monitoring
This section will be separated from part 1 and part 2. Collection of equality information is solely for monitoring purposes to
ensure that our policies and procedures are effective. We also collect this data in accordance with the general and specific
public sector equality duties under the Equality Act 2010. Any data you enter onto this monitoring form will only be used
for monitoring purposes and will not be used in assessing and or scoring your application or during the interview process.
This information is kept fully confidential and access is strictly limited in accordance with the Data Protection Act.

Please Please
Ethnicity Workforce census code Sexual orientation
tick tick
White WBRI British English Welsh Northern Irish Scottish x Bi-sexual
WIRI Irish Gay Man
WIRT Traveller of Irish Heritage Gay Woman
WROM Gypsy / Roma Heterosexual x
WOTH Any other White background Other
Mixed MWBC White and Black Caribbean Prefer not to say
MWBA White and Black African
MWAS White and Asian
MOTH Any other Mixed background Please
Gender
tick
Asian or AIND Indian
Asian British Female x
APKN Pakistani Male
ABAN Bangladeshi Transgender
CHNE Chinese Prefer not to say
AOTH Any other Asian background
Black or BCRB Black – Caribbean
Black British
Personal Please
BAFR Black – African
relationship tick
BOTH Any other Black background
Single
Other ethnic ARAB Arab
group Living together x
CHNE Chinese
Married
REFU Refused/Prefer Not to Say
Civil Partnership
OOTH Any other ethnic group
Prefer not to say

Religion or belief Please tick Disability

Please tick
No religion Do you consider that you have a disability?
Yes - Please complete the grid below
Christian (including Church of X
England, Catholic, Protestant and all No x
other Christian denominations) Prefer not to say
Buddhist
Hindu My disability is:
Physical Impairment
Jewish
Sensory Impairment
Muslim
Mental Health Condition
Sikh Learning Disability/ Difficulty
Any other religion (Write in) Long standing illness
Prefer not to say Other
Prefer not to say

March 2018
March 2018