Please return the completed form to:
HR
Sentinel Leisure Trust
Waterlane Leisure Centre
Water Lane, Lowestoft
Suffolk, NR32 2NH
Email: [email protected]
Please mark Private & Confidential
Closing Date:
Job Title:
Post No:
This form may be completed either in ink and returned by post, or electronically and returned via email.
PERSONAL DETAILS
Title: Mr / Mrs / Ms / Miss
First name(s):
Surname:
Preferred name (if applicable):
Address:
Home telephone number:
Mobile number:
number:
Mobile
Work telephone number (if it may be used):
Postcode:
National Insurance No:
E-mail address:
PRESENT EMPLOYMENT (IF APPLICABLE)
Employer:
Key responsibilities:
Date started:
Address:
Current salary:
Job title:
Notice required:
KEY ACHIEVEMENTS IN EMPLOYMENT, EDUCATION, PLACEMENTS OR VOLUNTARY WORK
Dates
Name of Employer/ Agency/
Voluntary Organisation
Please explain briefly your key achievements
Please complete this application form thoroughly to be considered for the post. Incomplete applications will not be considered for short
listing. CV’s will not be accepted individually or as part of this application.
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EDUCATION
School / College / University
Subjects passed with grade/ qualification
obtained
e.g. GCSE, A level, Btec, Degree etc.
Pass level or grade
Date passed
OTHER TRAINING & PROFESSIONAL QUALIFICATIONS
Course title
Course provider
Year attended
Expiry date of
Qualification
PREVIOUS EMPLOYMENT, PLACEMENTS OR VOLUNTARY WORK (last five years & most recent first)
Dates
from & to
Name and address of
Employer/Agency or Voluntary Organisations
Post held
and duties
Salary (for last
5 years only)
Reason for
Leaving
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PREVIOUS EMPLOYMENT continued
ENTITLEMENT TO WORK IN THE UK
Are you currently eligible to work in the UK?
YES
NO
If YES, and there are conditions attached, for example start and finish dates, please specify the details here:
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If NO, what type of work permit do you require?
............................................................................................................................................................................................................................................
To comply with the Asylum & Immigration Act 1996 and additional amendments, all prospective employees will be asked to supply
evidence of eligibility to work in the UK. We will ask to see and take a copy of an appropriate official document as set out in the Home
Office guidelines – however do not send these now, further information will be sent to you should you be invited to interview.
DISABILITY
HEALTH
Are you disabled? Yes/No
If you are, please read the attached guidance and:
Please give details of any aspect of your medical history which
could be relevant to the job for which you are applying.
a) provide details of your disability
b) advise of any adjustment that you might require at the
workplace or to the duties of the post
How many days absence have you had from work/college in the
last 12 months? (Anyone unemployed is likely to answer ‘None’).
This information is required by the Trust to enable it to fulfil its
obligations under the Disability Discrimination Act 2005
Do you consider yourself fit to carry out the duties required in the
job description of this post.
YES
NO
UNSURE
CONVICTIONS
Please give details of any convictions you have for criminal offences, (note: Some convictions become ‘spent’ after a specified period of
time and need not be declared - Rehabilitation of Offenders Act 1974). In addition, for jobs with access to children or vulnerable adults
the Trust will check the successful applicant’s details with the Criminal Records Bureau. If necessary you will be asked to sign a
separate authorisation to this effect.
I have a criminal conviction
YES
NO
(If Yes, please give details below)
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REFERENCES
To be taken up if shortlisted. One referee should preferably be your current/ most recent employer.
Name:
Name:
Address:
Address:
Postcode:
Postcode:
E-mail Address:
E-mail Address:
Telephone number:
Telephone number:
Employer
Education
May we contact prior to
interview?
Personal
YES
Employer
NO
May we contact prior to
interview?
Education
YES
Personal
NO
DECLARATION & DATA PROTECTION STATEMENT
Do you hold a current full driving licence?
YES
NO
Are you related to any Trustee or employee of Sentinel Leisure Trust?
YES
NO
If yes please give details:
To the best of my knowledge the information on this form is correct.
I understand that canvassing employees or Trustee’s or giving false information or omitting to give information could disqualify my
application and, if I am appointed, would lead to an offer being withdrawn or my dismissal.
Signed: .......................................................................................
Date: ...........................................................................................
In completing and returning this application you are consenting to the processing of data therein and that this will comply with the Data
Protection Act 1998.
The information you have supplied with your application will be used for monitoring our equal opportunities policy and may be processed
by computer or form the basis of manual records. Sentinel Leisure Trust requires the data for operational, managerial and associated
purposes relevant to the payment of remuneration, pensions, and the maintenance of the Human Resources system for all its emp loyees.
Where your application has been unsuccessful your details will be held on file for up to one year and will then be destroyed
PLEASE NOTE
If you receive no communication within 3 weeks of the closing date please assume that you have been unsuccessful and accept the
Trust’s gratitude for your interest shown in applying for the post.
FOR OFFICE USE ONLY
Selected/Not Selected
(a)
At a short-list stage
(b)
After an interview
Yes
No
Reason
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SUPPORTING INFORMATION
1.
Please explain why you are applying for this post.
3.
What activities outside work interest you?
2.
What skills and abilities can you bring to the job?
Page 5
HIGHLY CONFIDENTIAL
EQUALITY OF OPPORTUNITY IN EMPLOYMENT
MONITORING QUESTIONNAIRE
Job title:
Post No:
Grade of post applied for:
Surname:
First name(s):
Date of birth:
Gender:
Marital status:
please tick
please tick
Female
Male
I am currently in the following age group:
please tick
Single
Married
16-25
36-45
56-64
Civil partnership
Prefer not to disclose
26-35
46-55
65 and over
Ethnic Origin (The following are the new ethnic origin categories that were used in the 2001
population census. They are recommended by the Commission for Racial Equality and are the basis
for reporting statutory performance indicators.)
White
British
Please tick one box
Irish
Any other white background (please write in)
Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background (please write in)
Asian or Asian
British
Indian
Pakistani
Bangladeshi
Any other Asian background (please write in)
Black or Black
British
Caribbean
African
Any other Black background (please write in)
Chinese or other
ethnic group
Chinese
Any other (please write in)
Nationality
Please tell us your nationality:
Religion or Belief
Prefer not to
disclose
(Please see guidance notes for more information on why we are asking for this information)
Please select from list:
Baha’i
Buddhist
Christian
Pagan
Hindu
Muslim
Jain
Jewish
Rastafarian
Sikh
Zoroastrian
Humanist
No religion/belief
Prefer not to disclose
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Sexual Orientation
(Please see guidance notes for more information on why we are asking for this information)
Please select from the following list:
Heterosexual
Gay
Bisexual
Lesbian
Prefer not to disclose
Disability
The Disability Discrimination Act 1995 defines a person as having a disability if he/she has a physical or mental impairment which has a
substantial and long term adverse effect on his/her ability to carry out normal day to day activities.
Do you have a disability as defined above?
YES
NO
If you have a disability, are there any arrangements which we can make for you if you are called for an interview and/or work based
exercise?
YES
NO
If Yes, please specify, (e.g. ground floor venue, sign language interpreter, audio tape etc.)
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We offer a guaranteed interview to all disabled candidates who meet the minimum criteria for a job vacancy.
Where did you see this vacancy
advertised?
Page 7
INFORMATION FOR DISABLED APPLICANTS
The Disability Discrimination Act 2005 (as amended) define disability as a physical or mental impairment which
has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities.
Explanations of the components of this definition are given below:
Physical impairments - these affect the senses, such as sight and hearing.
Mental impairments - these include learning disabilities and mental illness (if it is recognised by a respected
body of medical opinion).
Substantial - this is something which is more than minor or trivial. It reflects the general understanding of
disability as a limitation going beyond the normal differences in ability which might exist among people.
Long-term - these are effects that:
 have lasted at least 12 months; or
 are likely to last at least 12 months; or
 are likely to last for the rest of the life of the person affected.
Long-term effects include those which are likely to recur.
Day-to-day activities - these are normal activities carried out by most people on a regular basis and must
involve one of the following broad categories:
 mobility - moving from place to place
 manual dexterity - for example, use of the hands
 physical co-ordination
 continence
 the ability to lift, carry or move ordinary objects
 speech, hearing or eyesight
 memory, or ability to concentrate, learn or understand
 being able to recognise physical danger.
The following particular cases or conditions are also covered under the legislation:
 severe disfigurements (even though they have no effect on a person's ability to carry out normal day-today activities)
 progressive conditions where impairments are likely to become substantial, such as cancer or HIV
infection (the Act covers people with these conditions from the moment there is a noticeable effect on
normal day-to-day activities, however slight).
Certain conditions are specifically excluded, such as:
 substance addiction (unless it is medically prescribed)
 tendency to set fires or steal
 hayfever (unless it aggravates the effects of another condition)
 disfigurements due to tattoos or non-medical body piercing.
Please note that, generally, eyesight corrected by spectacles or contact lenses will not be considered a disability.
Throughout the Trust we are committed to the need to:
 promote equality of opportunity between disabled people and others;
 eliminate unlawful disability discrimination;
 eliminate harassment of disabled people that is related to their disabilities;
 promote positive attitudes towards disabled people;
 encourage participation by disabled people in public life; and
 take steps to take account of disabled people’s disability, even where that involves treating the disabled
person more favourably than other people.
If you are disabled, please indicate this on the monitoring questionnaire and also complete the relevant section of
the application form. We will happily look at any adjustments that may be necessary for you.
Disabled applicants who meet the essential requirements of the appropriate person specification will
automatically be selected for interview. This is part of Sentinel Leisure Trusts commitment to the Employment
Service's Disability Symbol.
The Trust will be glad to assist if you have any particular queries relating to disability. Please note that this leaflet
includes general guidance only about a section of the Disability Discrimination Acts 1995 and 2005, and should
not be treated as a complete and authoritative statement of the law.
Page 8
EQUALITY OF OPPORTUNITY IN EMPLOYMENT
Sentinel Leisure Trust wholeheartedly supports the principle of equality of opportunity in employment. Although
there may be occasions when we can justify discrimination, the Trust is generally opposed to it on the grounds of
gender, marital status, sexual orientation, race, colour, nationality, ethnic or national origin, religion, disability or
age. It is in both the Trust’s best interest and those who work for it to ensure that the attributes, talents and skills
available throughout the community are considered when employment opportunities arise.
The overriding principle is that jobs should be filled by those best able to do them. Every possible step will be
taken to ensure that the Trust’s staff and potential staff are treated equally and fairly and that all employment
decisions (including those on recruitment, selection, promotion and training) are based solely on criteria related
to the job in question.
In order to help the Trust carry out its commitment to equality of opportunity in employment, you are asked to
complete the questionnaire overleaf. The information gathered will help the Trust to monitor the effectiveness of
its policy.
Please be assured that your answers will be treated in confidence and that this sheet will be retained by
the Trust for up to one year and then be destroyed. It will not be seen by the staff responsible for shortlisting or interviewing applicants.
Please return the completed questionnaire with your application form. If selected, your date of birth will be
released for pay and pension purposes.
Thank you for your co-operation.
Definition of Disability
The Disability Discrimination Act 1995 definition of disability is:
“a physical or mental impairment which has a substantial and long term adverse effect on a person’s
ability to carry out normal day to day activities”
The definition is intended to include all forms of physical and mental disability including sensory impairment,
mental illness and learning disabilities. (Mental impairments are those that are clinically recognised
conditions). It includes people who have a disability where the condition is likely to last longer than 12
months or is likely to recur.
If you are still not sure if your condition or impairment is a disability for this purpose, you might like to answer
these questions:
Is your condition likely to last longer than 12 months or be something that will recur?

Yes

If you were not taking regular medication or treatment, as appropriate, would your condition
have only a minor or trivial impact on your ability to carry out normal day to day
functions?

No, it has a substantial effect

Your condition is probably defined as a “disability” for these purposes


No
Yes
Here is a list of day to day activities to help you answer the second question above:
 Mobility – moving unaided  Manual dexterity – use of
 Ability to lift, carry or otherwise move
from place to place
the hands
everyday objects

Continence

Physical co-ordination


Perception of the risk of
physical danger

Memory or the ability to
concentrate, learn or
understand
(* a sight impairment corrected by wearing
spectacles or contact lenses is not a
disability)
Speech, hearing, sight*
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