Post Applied For: *

Please ensure you have indicated above the post you are applying for

CONFIDENTIAL

Personal Details

Surname: *

First Names: *

Title: *

Have you ever been known by any other name? *

If Yes, please give details:

Home Address: *

Postcode:

Daytime Tel No:

Mobile Tel No:

Email Address:

Preferred Contact No:

Nationality: *

Do you require any special arrangements if requested to attend for interview? *

If Yes, please give details e.g. wheelchair access required / sight or hearing impairment etc.

Employment History

In this section, please tell us about your employment history over the last 10 years.

Current Employer

Current Employer Name:

Current Employer Address:

Current Employer Postcode:

Current Employment Position Held:

Current Employment Date Commenced:

Current Salary:

Current Employment : Brief description of your main duties & responsibilities:

Current Employment : Period of notice required:

Previous Employment

Please list your previous employment, including organisation name, dates from/to, job title and responsibilities, and your reason for leaving, starting with the most recent.

Previous Employment Details:

Your Skills (1000 word limit)

The Ombudsman is committed to improving public services in Wales. Details of the Job Description and Person Specification have been sent to you with this application form. Please use this information to tell us in this section how your skills, experience and achievements will help you to contribute in this post to the Ombudsman’s objective.

Your Skills

Qualifications

Starting with the most recent, please list your qualifications, education and membership of professional organisations.

Education

Please list dates, school/college/university name, Course of study / Qualifications & Grades achieved

Education details

Training

Please list Dates, Training Body, Course of Study and Qualifications gained if applicable.

Training Details

Professional Membership(s)

Please list membership of professional organisations, including name of organisation, membership level, and dates from / to

Membership of professional organisations details

References

Please provide the name and contact details of two referees, one of whom should be your current or last employer. Referees will be contacted following an offer of employment and the Ombudsman reserves the right to contact any or all of your previous employers for additional references if it is felt appropriate.

Reference 1

Reference 1 Name:

Reference 1 Job Title:

Reference 1 Organisation:

Reference 1 Address:

Reference 1 Postcode:

Reference 2

Reference 2 Name:

Reference 2 Job Title:

Reference 2 Organisation:

Reference 2 Address:

Reference 2 Postcode:

Criminal Convictions

Have you ever been convicted of any criminal offences that are not yet spent under the Rehabilitation of Offenders Act 1974.

If Yes, please provide details in a separate, sealed envelope clearly marked with your name.

Welsh Language Skills

Are you able to communicate in Welsh? *

If Yes, how would you assess your level of ability in relation to the following?

Welsh Speaking

Welsh Understanding

Welsh Reading

Welsh Writing

Are you able and willing to work in the medium of Welsh?

If you have answered “yes” your Welsh language skills will be tested should you be shortlisted for assessment and interview.

Ability to drive

Do you hold a full UK driving license? *

If yes, do you have access to a car?

If yes, do you hold Business Use Insurance?

Permanent or Fixed Term Contract

If you are offered a position with the Ombudsman’s office, are you interested in:

Fixed Term Contract

Permanent Contract

Data Protection

Under the Data Protection Act 1998, the Public Services Ombudsman for Wales must not retain personal information for longer than necessary. All unsuccessful applications will be kept for 12 months after the closing date for applications.

The Recruitment Panel’s decision notice and master matrix will also be destroyed after 12 months. Individual notes, matrices and score sheets of the Recruitment Panel will be destroyed at the end of the interview process.

The successful applicant’s details will be transferred to their personnel file.

Consent & Declaration

For the purposes of the Data Protection Act 1998, I consent to the information contained within this application and any other documents in support of this application, being processed for the purposes of the recruitment process.

I declare that the information I have given in this application is true and accurate to the best of my knowledge and I understand that if any false or misleading statements made on this form, subsequently come to light, I may be regarded as ineligible for recruitment or dismissed after my employment has commenced.

Signature (Print Name): *

Date *

Equal Opportunities Monitoring

The Public Services Ombudsman for Wales strives to ensure that people using his service, or who are employed by him, are treated equally and that he does not inadvertently discriminate against members of any particular group in society. In order to help us monitor this, we would be grateful if you could complete and return this form. If you are not comfortable answering any particular question, please select ‘prefer not to say’. This is not compulsory and the return or otherwise of this form does not form part of the recruitment process.

What was your age last birthday?

What is your gender?

How would you describe your nationality?

What is your ethnic group?

What is your household’s main language?

Do you consider yourself to be disabled?

Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

What is your religion?

Are you married or in a same sex civil partnership?

Which of the following options best describes how you think of yourself?

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