IMB Application Form - Amazon S3



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| |Application Form |

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|Campaign Reference (can be found within |      |

|the advertisement) | |

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|Note: |

|All fields are mandatory; if a section does not apply to you, please do not leave blank but write ‘Not applicable’. Incomplete forms |

|may not be considered. |

|Please also complete the Political Activity Form, which is a mandatory part of your application. |

|We would also appreciate your taking the time to complete our Diversity Monitoring Form. This information will always be treated in |

|confidence and it will allow us to run more successful recruitment exercises in the future and ensure that competitions are fair for |

|all. |

Section A – About Yourself

|Family Name |      |

|Title (Mr/Mrs/Ms etc.) |      |

|Full Forenames |      |

|Previous Family Name(s) |      |

|National Insurance Number |      |

|Current Home Address |      |

|Postcode |      |

|Contact Telephone Number |      |

|Email address |      |

|How much time are you able to volunteer per |      |

|month | |

|Do you have the right to work in the United Kingdom? (If you do not have the right to work in this country | Yes | No |

|your application will not be accepted) | | |

| | | |

|Have you been resident in the UK for the past 3 years? | Yes | No |

If you answer ‘Yes’ to any of the next three questions, please give details in the box below

|Are you subject to immigration control? | Yes | No |

|Are there any restrictions on your continued residence or | Yes | No |

|employment in the UK? | | |

|Have you spent more than 6 months in total out of the UK | Yes | No |

|in the last 3 years? | | |

If you answered ‘Yes’ to any of the last three questions, please give details in the box below

|      |

|Note: Since security (Disclosure Barring Service - DBS) checks cannot cover any period of time that a candidate has lived abroad all |

|candidates who have lived abroad for more than six months in the last three years are required to produce a Certificate of Good Conduct |

|from that/those country/countries. Please note that this is any period of time totalling six months not necessarily six consecutive |

|months. Responsibility for obtaining certificates of good conduct including any financial costs incurred falls to you as the candidate. |

Section B – Employment

Please provide details of any paid employment you have had in the past five years or your last two jobs. Please indicate if you are retired and provide details of your last role whilst in employment.

|Employer |Position held |Nature of work |Dates Employed |

|      |      |      |      |

|      |      |      |      |

dSection C – Activities not related to employment including any volunteering roles

Please provide details of activities and interests and volunteer roles that may be of relevance to your application, give details below and explain any abbreviations used.

|Activities and interests |Nature of activities and interests |Dates |

|      |      |      |

Section D Ministerial and/or Public Appointments

Is this your first public appointment?

| Yes | No |

Please give details of any Ministerial and/or Public Appointments already held with dates of appointment.

|Public or Ministerial Appointment |Nature of Appointment |Date of Appointment |

|      |      |      |

Section E – Convictions

The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 applies to applicants for, and members of PECS Lay Observers. This means that you must provide details of any convictions and cautions (spent or unspent) that you may have other than protected convictions or cautions. This link takes you to the DBS website for information on protected and unprotected cautions and convictions – .uk/government/uploads/system/uploads/attachment_data/file/266123/Filtering_guide-v2.3.pdf. See also the accompanying notes for further guidance on protected cautions and convictions.

If you are convicted of a criminal offence or are the subject of any court order after you have completed the form, and while your application is still under consideration, you must notify the Lay Observers Secretariat. This may not invalidate your application.

If you answer ‘Yes’ to any question in this section, please provide full details, including dates of when you were on probation, received a conditional discharge or were bound over after being charged with any offence and the location where it occurred in the box at the end of this Section. This may not invalidate your application.

Community Sentences

|Are you subject to a community order, on conditional discharge, or bound over, after being charged with any | Yes | No |

|offence? | | |

|Actions Pending | Yes | No |

|Have you been charged with any offence which is still pending? | | |

|Cautions | Yes | No |

|Have you ever received a caution or a conditional caution? | | |

If you answered ‘Yes’ to any of the questions in this section, please provide full details including the nature of the offence, where it occurred and the outcome.

|Nature of Offence, including Location and Date |Outcome |

|      |      |

Section F – Conflicts of interest and other information

One of the most important requirements for Lay Observers is that they perform their duties impartially and objectively. It is also vital that the public has confidence in the impartiality of Lay Observers. Even a perceived conflict of interest on the part of a Lay Observer can be damaging to the reputation of the organisation. All prospective Lay Observers will therefore be asked at interview to declare any personal direct or indirect interests, connections or obligations which could, or could be perceived to, influence their actions, decisions or judgment, or make it difficult for them to fulfil their duties fairly.

|Are you related to, or acquainted with, anyone who is serving or has served a custodial sentence in a prison | Yes | No |

|or been convicted of a criminal offence or is currently or has been remanded in custody or received a | | |

|community disposal order? | | |

|Are you related to, or acquainted with, anyone who works in a prison? | Yes | No |

|Do you know anyone who is serving or has served as a Lay Observer? | Yes | No |

|Do you provide any service or have business with and/or other interests which might give rise to a conflict, | Yes | No |

|or a perceived conflict of interest (please refer to the enclosed document for further information) in the | | |

|context of your service as a Lay Observer? | | |

If you answered ‘Yes’ to any question in this Section, please provide further details below

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Section G – How did you hear about PECS Lay Observers?

Please indicate how you found out about the PECS Lay Observers. Please specify names of websites, newspapers, events or name of existing Member who gave talks etc.

| | |Name of website or place or publication or place where you FIRST saw these |

| | |vacancies advertised |

|Lay Observers website | |      |

|Facebook | |      |

|Cabinet Office Public Appointments website | |      |

|Third Sector website | |      |

|Through a Google search | |      |

|Other website (eg Charityjob, Reach Skills, Clinks, | |      |

|Do-It) | | |

|Newspaper article or advert | |      |

|Leaflet or Poster (please specify where you saw this) | |      |

|Other Organisation or event | |      |

|(please specify which organisation) | | |

|Volunteer Centre | |      |

|Word of Mouth (please specify if by an existing Lay | |      |

|Observer) | | |

|Other (Please provide details) | |      |

Section H - Guaranteed Interview Scheme Declaration

|I consider myself to have a disability as defined under the Equality Act 2010, and I would like to apply under| Yes | No |

|the Guaranteed Interview Scheme. | | |

|Do you require any special arrangements to be made to enable you to attend or undertake a familiarisation | Yes | No |

|visit or interview? | | |

If yes, please provide further details in this box:

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Section I – Competencies

Finally, we would like to know a little more about you and what you could bring to the role as a Lay Observer. Using the blank space below and overleaf and referring to the following competencies, please tell us about yourself. To do this, you might find it helpful to read the competencies section within the ‘Guidance on Completing the Application Form’ leaflet. You may also find it helpful to refer to the ‘Useful Information’ leaflet and other information on the Lay Observer website for further background about the PECS Lay Observers.

➢ Commitment, Quality and Consistency

➢ Objectivity, Observation and Analysis

➢ Communication, reporting and IT skills

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Section J – Declaration

I have read the Guidance on completing the application form. If appointed, I will undertake the required training. The information given in this application is true and accurate to the best of my knowledge and belief. I undertake to notify the Secretariat if at any time there is a material change in the information I have given. I understand that by deliberately providing false or misleading information my appointment will be terminated.

If returning this form by email, please type in your signature and date. If returning this form by post, please sign and date the form by hand.

|Signature |      |Date |      |

Please return your completed application by the closing date to:

By Email: LOrecruitment@justice..uk

By Post: Lay Observers Secretariat

10 South Colonnade

Canary Wharf

London

E14 4PU

Now please complete the Diversity Monitoring Form

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