Application Form WEPC Application Form Step 1 of 6 16% Your Personal InformationPosition you are applying for:Your Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussian FederationRwandaRéunionSaint 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 TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Your Email Address Enter Email Confirm Email Your Phone Previous Employment & EducationYour Previous EmployersPlease list your previous employers, starting with your most recent employment. EmployerDatesPosition & SalaryDuties & ResponsibilitiesReason for Leaving Add RemoveReferencesPlease provide details of two referees, one of which should be your most recent employer. Referees will not be contacted unless you have been successful in obtaining this position. Name of RefereeJob TitleEmailTelephone Number Add RemoveEducationEducation ProviderSubjectGrades/QualificationsDates Add Remove More About YouTell Us About Yourself Do you have any criminal convictions, which are not yet spent under the Rehabilitation of Offenders Act 1974? Yes No If yes, please provide details in the box below.Do you hold a current UK driving licence? Yes No Are you related to, or do you have a close personal relationship to any Councillor or member of staff at West End Parish Council? Yes No If yes, please provide details in the box below.Do you have any restrictions regarding your employment? For example, do you require a work permit? Yes No If yes, please provide details in the box below. If you require us to make any adaptations for your interview to accommodate any disability you may have, please details below what these would be:If successful, please confirm what date you would be available to start from and any notice period you would have to workHours You Are Available for WorkPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFridaySaturday Add RemoveDeclaration(Required)West End Parish Council requires all applicants to undertake Disclosure and Barring Service checks prior to the post commencing. By signing this declaration, you consent to West End Parish Council using and keeping the information provided by yourself and any referees. This information will be used solely in the recruitment process. If a copy of our Privacy Statement is required, please contact us in writing at West End Parish Council, Chapel Road, West End, Southampton, SO30 3FE. I confirm that the information supplied in this application is true and corrected to the best of my knowledge. I understand that should my application be successful, and it is proven I have given false information, my employment will be terminated with immediate effect. I agree to the declaration. Equality & Diversity QuestionnaireWest End Parish Council wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010 and building an accurate picture of the make-up of the workforce in encouraging equality and diversity. The organisation needs your help and co-operation to enable it to do this but filling in this form is voluntaryGender Male Female Intersex Non-Binary Prefer not to say If you prefer to use your own gender identity, please specify below:Gender 16-24 25-32 33-40 41-48 49-56 57-64 65+ Prefer not to say EthnicityPlease provide details belowReligion Buddhist Christian Hindu Jewish Muslim Sikh Prefer not to say If you prefer to use your own gender identity, please specify below:Do you have any caring responsibilities? If yes, please tick all that apply: Primary carer of a child/children (under 18) Primary carer of a disabled child/children Primary carer of a disabled adult (over 18) Primary carer of an elderly person Secondary carer Prefer not to say Δ
