CONFIDENTIAL

Please refer To Guidance Notes for Candidates before completing this form. *If you do not hear from us within
21 days of submitting this application, then on this occasion you have not been successful .* Use the tab key to move
between fields.

Application for the post of:

Post No:

Where did you see this post advertised?

Page 1
Personal Details
Are you aged
Title 16 or over? Yes No

Surname Forenames

Full address
including
postcode

Home Tel No Mobile No

Email Address NI Number

Daytime Telephone number

Are you related to any Elected Members or employees of Cherwell District
Yes No
Council?

If YES please give name(s) and relationship

Do you have a current driving licence? Yes Licence Status –

or No Full or Provisional
Disability - If you have a disability which you wish to be taken into account in the recruitment process, please give
brief details in the space provided at the end of this application form in the Monitoring Equal Opportunities Section.
You are not required to declare any disability that you may have at this stage of the recruitment process.

Education and Relevant Courses

Name of school, college, university,
organisation etc where you have Examination or relevant course Result or Grade
(You will be asked to produce evidence of
obtained qualification or relevant subject taken or to be taken. examination results)
course

Page 2
Present or Most Recent Employment
Name of employer

Full address of
employer including
postcode

Post title

Date of appointment

Date and reason

Period of notice required for leaving (if
(if applicable)
applicable)

Please give a brief description of your main duties and responsibilities, the box will expand as required:

Previous Employment
Most recent first, up to 10 years (explaining any gaps in employment history).
NB. If the post you are applying for has been identified as having contact with children, young people and/or vulnerable
adults a FULL employment history should be provided.

Employer Dates Post Title and Nature of Duties

From To

Page 3
Relevant Experience and Skills
Using the STAR method (Situation, Task, Action, Result) and the person specification to guide you, please give
details of any experiences and skills that you feel are relevant to the post. The box will expand as you type to add
as much information as is required for your application. This box will expand as required.

Membership of Professional Bodies You may be asked to produce evidence of membership

Institution or Society Class of membership Date obtained State if by Prizes or

examination awards

References
Please provide full details of at least two referees (one of which should be your current or most recent employer).
You must not be related to your referees or have had any form of close personal relationship. Your referees cannot be
Elected Members of the Council. If you are a student, then your head teacher or tutor must be named.

If the post you are applying for has been identified as having contact with children, young people and/or vulnerable
adults and you have also worked with any of these groups before, then details of a referee must also be provided for
that role. You may continue on a separate sheet if necessary.
May we contact this referee without May we contact this referee without
further authority from you? – Yes / No further authority from you? – Yes / No

Name Name
Address Address

Tel No Tel No

Email Email
Address Address
In what capacity does this person know you? In what capacity does this person know you?

Declaration

Rehabilitation of Offenders Act 1974. Candidates need not give details of spent offences except where the post is
exempt from the Rehabilitation of Offenders Act 1974. If you are applying for a post which is exempt from the
Rehabilitation of Offenders Act 1974 this will be specified in the Information for Applicants and a criminal record or ISA
registration check may be required before an appointment is confirmed.

Do you have any convictions, cautions, reprimands or final If YES, please give brief details
warnings that are not 'protected' as defined by the Rehabilitation below:
of Offenders Act (Exceptions) Order 1974" – Yes / No

Are you currently the subject of any Police investigations If YES, please give brief details
following allegations made against you? – Yes / No below:

Date Nature of offence

Court Sentence
Privacy Notice

Recruitment Application
What information do we collect?
As part of any recruitment process, Cherwell District Council collect and process personal data relating to job
applicants. The organisation is committed to being transparent about how it collects and uses that data and meets its
data protection obligations.

Personal information is any information about an individual from which that person can be directly or indirectly
identified.

Contact details specific to service

If you have any queries that are specific to how your personal data is used as part of our recruitment process contact:
[email protected] or write to Human Resources, Cherwell District Council, Bodicote House,
Bodicote, Banbury, Oxfordshire, OX15 4AA

How we use your information collected

The information you provide will be used to confirm your identity and process your job application.

Other than employment agencies, the Council will only seek personal information from third parties during the
recruitment process where consent is given to contact your references and also once an offer of employment or
engagement has been made to you, we will inform you that we are doing so.

Who will have access to my personal data?

The information you provide will only be used by the Council and will not be shared with any other organisation without
obtaining your consent.

The Council take all precautions to ensure your personal data is secure and used only for the purposes for which it was
obtained, unless permitted by law to process it for other purposes.

What information is processed?

The Council process a range of personal information about you during the recruitment process. This includes:

• your name, address, contact details and NI number

• personal information included in a CV, any application form, cover letter or references we obtain
• any disability, for which the Councils needs to make reasonable adjustments

If you fail to provide certain personal information when requested, we may not be able to process your job application.

Retention period
Unless required for an ongoing investigation, the information provided will be retained for 6 months after which time the
information will be securely destroyed. Information retained for an ongoing investigation will be securely destroyed as
soon as it is no longer required.

Summary of rights
You have a number of statutory rights to the information we hold on you, which includes access. These are explained
in the “Summary of the data subject’s rights” section of our website found under https://www.cherwell.gov.uk/privacy-
and-cookies. Here you will also find the councils privacy policy. Alternatively, you can request this information by email:
[email protected]

Or by post:

The Information Governance Team

Cherwell District Council
Bodicote House
Bodicote
Banbury
Oxfordshire
OX15 4AA

Declaration
I understand that canvassing of any Members of Cherwell District Council in connection with any appointment shall
disqualify the candidate.
I understand that a medical examination may be necessary in connection with this post and that appointment is subject
to satisfactory medical clearance.
I declare that the information given in this application is to the best of my knowledge true and complete.

Signed Date

Please send the completed form via email to [email protected] or in an envelope marked CONFIDENTIAL to:
Human Resources, Bodicote House, Bodicote, Oxon, OX15 4AA. Receipt of your form will be acknowledged by an automated email
or if using the postal service will only be acknowledged if you enclose a stamped addressed envelope.
Monitoring Equal Opportunities
Cherwell District Council is committed to being an equal opportunities employer. The Council does not discriminate on
the basis of race, religion or belief, colour, sex or sexual orientation, age, physical or mental disability, marital status,
nationality, ethnic or national origin. All matters related to employment are decided on the basis of qualifications, ability
and business needs.

This monitoring information section will not be kept with your application form and will not be used for
selection purposes. It will only be used for statistical monitoring purposes to ensure all applicants receive the
same consideration and are treated fairly when applying for jobs.

Please complete the Equal Opportunities Monitoring form below to enable us to monitor the effectiveness of our equal
opportunities policy in regard to our applicants.

Information will be treated in the strictest confidence and used only for monitoring purposes and will not form
part of the recruitment decision process.

Data is collected in accordance with the requirements of the Data Protection Act and Code of Practice issued by the
Chartered Institute of Personnel and Development.

If you are applying under the Veterans Guaranteed Interview Scheme, please ensure you state this on the Equal
Opportunities Monitoring form. The information provided must be clear, precise and aimed at the job you are
applying for.

Disabilities Disclosure Statement

Cherwell District Council is committed to providing a service that is inclusive of diversity and equality. In order for us to
provide such a service, we require you to complete the following declaration relating to disabilities. If you do not
consider yourself to have a disability, please tick the box at the bottom of the page.

The Council has a duty under the Equality Act 2010 to make “reasonable adjustments” for people with disabilities who
want to work for the Council or access our services. To do this it is important that you let us know if you have a
disability so we can make reasonable adjustments, for example at the interview/selection process.

In order to make adjustments, some information regarding your disability may have to be disclosed to various
members of staff. No information will be passed on unless it is relevant to making reasonable adjustments. You can
request that no information about your disability be passed on, or you can request that information is restricted to
certain people. However you should be aware that this could restrict the types of adjustments that can be made.

You should also be aware that even if you have stated that you do not wish information to be passed on, in certain
instances relating to health and safety, emergency evacuation or public policy there may be a need to do so.

As a Disability Confident Employer Cherwell District Council will offer an interview to disabled applicants who meet the
minimum criteria for the role.

Disability
Under the Equality Act 2010 the definition of a disability includes anyone with a physical or mental impairment which
has a substantial; long term adverse effect on their ability to carry out normal day to day activities. Cancer; HIV and
Multiple Sclerosis are included from the point of diagnosis.

Under this definition do you consider yourself to have a disability? Yes No

Do you wish the disability to be disclosed for interview purposes for

Yes No
relevant adjustments

What are the adjustments that need to be made for interviews

Personal and Post Details
Date of Birth:

Nationality:

Are you applying under the Veterans Guaranteed Yes No

Interview Scheme? (see guidance notes)

If so, please provide your last day of employment Date.

with the Armed Forces.

Do not wish to
Sex: Male Female Transgender
disclose

Living with
Single Married Civil Partner
Partner
Marital
Status
Widow/ Do not wish to
Divorced
Widower disclose

Christian Jewish Sikh Hindu

Religion or
Belief
Muslim Buddhist No religion

Heterosexual Lesbian Gay Bisexual

Sexual
Orientation Does not wish
to disclose

Indian Caribbean Pakistani African (1)

Any other
Any other
Bangladeshi Asian Chinese
background (2)
Background
Ethnic
Group White and White and
Any other mixed
Black Black White and Asian
background
Caribbean African

Do not wish to
British Irish Other
disclose

Ethnic Group Notes:

(1) Angolan, Congolese, Ghanaian, Nigerian, Sierra Leonean, Somali, Sudanese, any other Black African.

(2) Afghan, Kurdish, Latin/South/Central American, Vietnamese, any other ethnic group(Other) Turkish, Turkish
Cypriot, Traveller of Irish heritage, Albanian, Greek/Greek Cypriot, Gypsy Roma, White Western Europe, White
Eastern Europe, any other White.