be One in a million

job application form
Birmingham City Council is committed to equal opportunities in employment and we positively welcome your application irrespective of your gender, race, disability, colour, ethnic or national origin, nationality, sexuality, gender identity, marital status, responsibility for dependants, religion, trade union activity and age. FOR OFFICE USE
Job ref no: Date sent out: Date returned: Application no: Closing Date:

IT

Please complete all sections on the form. If any section does not apply to you, enter not applicable (n/a). It is important that you refer to the Guidance Notes before completing this form. Electronic versions of this form are available at www.birmingham.gov.uk/jobs This form is also available in large print, Braille or on audio tape on request.

1. Vacancy Details This section must be completed
Job title: Directorate: Service Area:

2. Personal Details
First name(s): Address: Last name: Former name(s): Title: e.g. (Mr,Mrs,Ms): Postcode: Daytime tel no: Mobile tel no: Evening tel no: Email:

Please indicate if you are happy to receive correspondence via your email address e.g. invite to interview letter National Insurance Number, if you have one Current driving licence (if this is a requirement of this job): If YES, type of licence

Yes

No

Yes

No

3. General Information
a) Are you related to a Councillor or employee of Birmingham City Council? Yes No If yes, please provide details: Name: Position: Relationship: Directorate:

4. Arrangements for interview
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 tapes etc).

b) Do you wish to job share the job you are applying for? Yes
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No

5. Education/Qualifications (including overseas) Please start with secondary education.
To mth yr From mth yr Secondary School/ College/University etc Examinations taken or to be taken Results & grades Date gained

6. Training Please list any course(s) which you have undertaken which are relevant to the job and/or specified on the person specification. Year Organising body Course title Length

Please continue on a separate sheet if necessary.

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7. Membership Please indicate membership of any organisation(s) relevant to this job.
Name of organisation Type of membership Date of membership

8. Past Employment & Experience (if any) include voluntary or other relevant experience.
To mth yr From mth yr Employer Job Title Reason for change

Please continue on a separate sheet if necessary.

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9. Present or Most Recent Employment (if any)
Job title: Salary: Date Started: Address: Postcode: Reason(s) for leaving (if applicable): Date left (if applicable): Employer:

10. Ill Health Retirement/Dismissal
Have you ever taken ill health retirement from Birmingham City Council or been dismissed for some other reason?

Yes
If yes, please give the date and department/directorate:

No

11. References Please give details of two referees one of which must be your current or most recent line manager/supervisor, or other person designated within the organisation to provide references. Please put a cross in the appropriate box(es) below if you do not wish us to take up a reference without your consent.
Name: Address: Postcode: Tel no: Job title: Email: Relationship to you:

If this referee knows you by another name please give that name: Name: Address: Postcode: Tel no: Job title: Email: Relationship to you:

If this referee knows you by another name please give that name: Please note some jobs may require a Criminal Records Bureau Check, further information regarding this will be contained in the application pack, if applicable.
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12. Other information in Support of your Application
In order for us to decide