Further Info Stage 2 application - Elysian

Throughout this form we ask for some personal data about you. We’ll only use this data in line with data protection legislation and process your data for 1 or more of the following reasons permitted in law:

· You have given us your consent by completing this form

· We must process it to comply with our legal obligation

Please note our Privacy Notice on the Resources tab on our website

Applicant Name

First

Last

Previous names and surnames (with dates), and any other names (e.g. a preferred name you like to be called)

Applicant Email

Applicant Phone Number

DISCLOSURE AND BARRING AND RECRUITMENT CHECKS

Elysian is legally obligated to process an enhanced Disclosure and Barring Service (DBS) check before making appointments to relevant posts.

The DBS check will reveal both spent and unspent convictions, cautions, reprimands and final warnings, and any other information held by local police that’s considered relevant to the role. Any information that is “protected” under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 will not appear on a DBS certificate.

For posts in regulated activity, the DBS check will include a barred list check.

It is an offence to seek employment in regulated activity if you are on a barred list.

We’ll use the DBS check to ensure we comply with the Childcare Disqualification Regulations. It is an offence to provide or manage childcare covered by these regulations if you are disqualified.

Any data processed as part of the DBS check will be processed in accordance with data protection regulations and Elysian’s privacy notice.

Do you have a DBS on the the update service?

Yes
No

DBS certificate number

NI Number

Have you lived outside the UK in the last 5 years?

Yes
No

What is your preferred start date (or approx. month)

As you are a shortlisted candidate, please read the following and complete the declaration below: Any job offer will be conditional on the satisfactory completion of the necessary pre-employment checks. As a shortlisted applicant, you are now required to complete a self-declaration regarding any criminal record or other information that may make you unsuitable for this position. Please note that we may also carry out online searches as part of our due diligence process. Any convictions you self-disclose, or that appear on a DBS check, will be reviewed on a case-by-case basis in line with our safeguarding and recruitment policies.

Declaration: (Please complete the section below to confirm your self-disclosure e.g. any criminal convictions)

Please give any details of professional or personal relationships you have with anyone associated with Elysian

Employment History

Most recent or current employment

1. Job Title and duties

FROM

TO

Employer details (Name of company, name of owner/manager address, email, phone number)

Salary

Reason for Leaving

Previous Employment

2. Job Title and duties

FROM

TO

Employer details (Name of company, name of owner/manager, address, email, phone number)

Salary

Reason for Leaving

3. Job Title and duties

FROM

TO

Employer details (Name of company, name of owner/manager, address, email, phone number)

Salary

Reason for Leaving

and Declaration: like

4. Job Title and duties

FROM

TO

Employer details (Name of company, name of owner/manager, address, email, phone number)

Salary

Reason for Leaving

5. Job Title and duties

FROM

TO

Employer details (Name of company, name of owner/manager, address, email, phone number)

Salary

Reason for Leaving

6. Job Title and duties

FROM

TO

Employer details (Name of company, name of owner/manager, address, email, phone number)

Salary

Reason for Leaving

Please ensure all employment has been submitted. Any other/further employment details need to be clear on your submitted CV (if not, please re-submit by emailing to apply@elysianuk.org).

Please provide details (dates etc) of any and ALL employment gaps since leaving school up until the present day and give the reasons for the gap

Education

FROM

TO

Place/School/University

Quaification/Results

FROM

TO

Place/School/University

Quaification/Results

FROM

TO

Place/School/University

Quaification/Results

Please outline any other relevant Qualifications and training for this post. Please include completion dates. For teachers please include TRN.

Where applicable, please upload any copies of relevant qualification or training certificates

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

References

Please provide full information for two referees who can comment on your skills and abilities for this position.
Please ensure that one of your references is your current or most recent employer.
Each reference needs to be from separate companies/employers
At least of one the references need to date back 5 years
In all cases the referee must be someone who has known you in a professional capacity, character references are not accepted.
Please ensure you include full details including phone number, Company name and email.
Please note the email address from your referee must be from a professional domain. This means we cannot accept emails that end in personal domains e.g. Hotmail, Gmail, Yahoo, etc.
References will be taken up as soon as possible and a job offer will depend upon receipt of satisfactory references.
Please make sure your From and To employment dates are correct and correlate with what your current/previous employer has, as this can delay the process significantly

*References are provided in confidence and therefore are not shared with applicants

Professional Reference 1 (must be current or most recent employer)

Reference 1 Name

First

Last

Company Name

Reference Email (professional email address required)

Relationship to Reference provider (e.g. current line manager)

Reference Phone Number

Employment period: MM/YYYY to MM/YYYY (ensure these correlate with what your referee has on file)

Professional Reference 2

Reference 2 Name

First

Last

Company name

Reference Email (professional email address required)

Relationship to Reference provider (e.g. previous line manager)

Reference Phone Number

Employment period: MM/YYYY to MM/YYYY (make sure these correlate with what your referee has on file)

Miscellaneous (any further note you would like to add/inform of)

Medical Fitness (do you have any medical conditions that may impact on the role) If yes, please describe:

Do you have any Allegies we should be aware of? If yes please describe:

Please note: Employees who transport young people as part of their role, travel across Elysian sites, participate in the Outreach program, or undertake any other work-related travel using a personal vehicle must ensure they have a vaild drivers licence and current car insurance that includes business use.

Do you authorise a full background and online check as part of the employment?

I consent

Date of Form completion

Applicant Name

First

Last

Applicant Signature

Clear Signature