CRB APPLICATION FORM
Wigan Council is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all staff and volunteer to share this commitment Vacancy Details Job Title: Job reference number: Site Manager SCH - 821 Advertising origin Where did you hear about this vacancy? www.yourcounciljobs.co.uk

It is Wigan Council’s policy to ensure that all appointments are made on merit. This form is for monitoring purposes only and will be kept separate from any members of the shortlisting or interviewing panel. In order to monitor the effectiveness and success of this policy it would be helpful to us if you provide the information requested below regarding your personal details. The details supplied by you on this form are confidential, but will form part of the personnel record of the successful candidate. Personal Details Title: First name(s): Last name: Known as: Date of Birth: Address: Postcode: Contact Number: Email address: National Insurance Number:

Mr Adam Woodcock 06/07/1986 1 Mendip Avenue, Winstanley, Wigan WN3 6EB Mobile: 07912411317 Home: 01942 226 083 adamw_ninja@hotmail.com

JS 58 74 65 B
Eligibility to work in the UK

Current legislation means that it is a criminal offence to employ a person who is subject to immigration control, unless he or she has documentary proof showing an entitlement to work in the UK. If selected for interview you will asked to provide proof of your work entitlements. Do you have an entitlement to work in the UK? YES

x

NO

1

EQUALITY AND DIVERSITY

Male Yes

x x

Gender Female No Ethnic Origin

Is your gender identity the same as the gender you were assigned at birth?

White

British Irish Traveller of Irish Heritage Gypsy/Roma Polish Other White European Other White

x

Mixed

White and Black Caribbean White and Black African White and