Job Application Form Δ Which role are you applying for?(Required)Early Years Deputy Manager and SENCoOvernights PlayworkerPlayworker – Camden SquarePlayworker – Fairfield (Camden Town)Playworker – Fortune GreenShort Breaks Worker1-to-1 KeyworkerYour Personal InformationYour TitleMsMrsMissMrOtherYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Your Phone Number(Required)Address(Required) Street Address Address Line 2 Town/City Postcode Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe National Insurance Number(Required)Do you have a current full driving licence?(Required) Yes NoAre there any restrictions on you taking up employment in the UK?(Required) Yes NoIf yes, please provide details about these employment restrictionsPrevious EmploymentYour Previous EmployersPlease list your previous employers, the dates you worked and the position you held. Press the plus icon on the right to add more entries.EmployerDatesPositionReponsibilities Add RemoveEducation and Training HistorySecondary EducationPress the plus icon on the right to add more entries.DatesName of InstitutionQualifications Gained Add RemoveFurther and Higher EducationPress the plus icon on the right to add more entries.DatesName of InstitutionQualifications Gained Add RemoveOther Relevant Training / QualificationsPress the plus icon on the right to add more entries.DatesName of InstitutionQualifications Gained Add RemoveSupporting StatementSupporting Statement – Skills, Abilities, Knowledge & Experience(Required)Please use the Person Specification to detail your specific reasons for this application and how you meet the requirements.ReferencesPlease give the names and addresses of two persons from whom we may obtain both character and work experience references. One referee must be your current / most recent employer or course tutor if you are currently in education. Please note PACE cannot accept references from friends or relatives.Referee 1 Name(Required) First Last Phone(Required)Email(Required)All reference emails must be a professional email address. Can we contact this person before the interview(Required) Yes NoReferee 2 Name(Required) First Last Phone(Required)Email(Required)All reference emails must be a professional email address. Can we contact this person before the interview(Required) Yes NoCriminal RecordThis includes any criminal convictions including those ‘spent’ under the Rehabilitation of Offenders Act 1974.Do you have a criminal record?(Required) Yes NoPlease provide details of any convictions, cautions or bind overs. Give date(s) and description(s):DisabilityThe Disability Discrimination Act (DDA) 1995 protects disabled people from unlawful discrimination. If you tell us that you have a disability we will make reasonable adjustments to your working environment and to your work arrangements and practices, if it is reasonable for us to do so.Do you consider yourself to have a disability?(Required) Yes NoPlease provide details of your disability:If you are invited to an interview and you believe that we should make reasonable adjustments for you, please describe what would be required.If you are are appointed to the role, what reasonable adjustments would be required?Disclosures and BarringDo you currently have a valid DBS certificate?(Required) Yes NoIs your DBS certificate on the update service? Yes NoDBS Certificate NumberIf you are happy to share your DBS Certificate with us, please write the certificate number here:Date of BirthIf you are happy to share your DBS Certificate with us, please share your date of birth here: Other QuestionsWhere did you see this job advertised?(Required)Interview availabilityPlease list any dates/times when you are not available for interviewDeclarationDeclaration(Required) I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
