Lichfield Diocesan Board of Finance
Email:  jo.durber@lichfield.anglican.org
(Please complete this application form electronically or in black ink) 

PART A: PERSONAL INFORMATION

Post applied for:	
		
Form Reference:
(office use only)	

Family name (block capitals):	
	Title:		
Preferred name:	
	
Names in full (block capitals):	
	
Address:	
	
Telephone No (that we may use to contact you):	
	
Email:		
	
Are you eligible for work in the UK?
https://bit.ly/2x7brQL 	
	
National Insurance Number:

PART B: EDUCATION & TRAINING
Based on the job description, list education, training, any relevant professional qualifications and membership of professional organisations. Please give dates.

PART C: EMPLOYMENT HISTORY

Starting with your current/most recent appointment (clergy applicants please state parish), indicate what you have done in the last 10 years. Please include the contact name and full address of previous employers.

Name and address of employer	Start and leave date	Post held and brief description of responsibilities	Reason for leaving	

PART D: INFORMATION IN SUPPORT OF YOUR APPLICATION 

Looking at the job description and person specification, give examples of how you meet the criteria. Examples can be taken from work, volunteering, community, extra-curricular activities etc. 
If this post has an occupational requirement (OR), please state how you meet this.

PART E: REFEREES

This section will be detached from the form as it contains information that is strictly private and confidential. It will not be seen by any member of staff, other than staff in the Human Resources Department and will not be considered in relation to the job for which you are applying. 

Yes/No	
Do you currently hold office, a bishops' licence or Permission to Officiate?

Have you ever been removed from office or had a bishop's licence or Permission to Officiate withdrawn or terminated?  If so, give details.

Please note: If you are ordained, you must supply the name of the last Bishop under whom you served.

1. Current/most recent employer/academic (please indicate)

Name:		
Job title:		
Phone:		
Email:		
Address:		

May we contact your current /most recent employer now?		
What is the period of notice you require in your current job?		
2. Previous employer/another manager/academic (please indicate)

Name:		
Job title:		
Phone:		
Email:		
Address:		

Clergy, ordinands and such employed lay people as have duties that require them to represent or speak on behalf of the Church (which, for the purposes of this policy, includes all employees of the national church) may not be a member of or promote or solicit support for a party or organisation whose constitution, policy objectives or public statements are declared in writing by the House of Bishops to be incompatible with the Church of England's commitment to promoting racial equality. This explicitly includes the BNP.

Yes/No	
Please confirm that you are able to comply with this:	

To the best of my knowledge and belief, the information supplied by me in each section of this form is correct. 
.

Signed:		Date:		
	
STRICTLY CONFIDENTIAL

PART F: ADDITIONAL INFORMATION  

Post applied for:		

Family name (block capitals):		Title:		
Names in full (block capitals):		

Disclosure of conviction(s) 

Applications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this job will not be taken into account. You are required to disclose any convictions, which are not ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974. For legal and accounting professions, you are required to disclose all convictions, including those that are ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974.

Have you been convicted of a criminal offence that is not spent? If yes, please give details of date(s), offence(s) and sentence(s) passed.

EQUAL OPPORTUNITIES MONITORING FORM

The Diocese of Lichfield wholeheartedly supports the principle of equality of opportunity in employment and believe in the benefits of a workforce drawn from a wide cross-section of the community.

You are invited to answer the questions below. Such information will be held securely and confidentially and solely for the purpose of monitoring. By completing and returning this form, you are consenting to the use of this information for this purpose. 
Please put an X in the relevant box. 

Gender            Female    	                     Male
Age                 16 – 25                26 – 35 	               36 – 45 	               46 +
Date of birth
Ethnicity	
	ASIAN	BLACK	MIXED	WHITE	CHINESE / OTHER
	Asian British	African	White/Asian	British	Chinese
	Bangladeshi	Black British	White/Black African	Irish	Any Other
	Indian	Caribbean	White/Black Caribbean	Other
	Pakistani	Other 	 Other
	Asian Other
Marital Status
Please indicate which of the following best describes your marital status.
Single	Married          		
Separated	Divorced
Widowed	Undeclared             
Civil Partnership
Where did you see this vacancy advertised?

Church press 		 Other daily newspaper*
Other*		                                           Website*
*Please specify
Disability – Equality Act 2010 
Please outline any reasonable adjustments you may need if invited to attend an interview. 

Signed:		Date: