CONFIDENTIALPlease read this form carefully

before completing it in type or dark ink

Application Ref No: (Office Use only)

JOB APPLICATION FORMWholetime Firefighter Inter-brigade Transfer

Please complete all sections of the form using font type (Arial 12).The outside pages of this application form (which contain all your personal details and the equal opportunities information) will be detached and will not be used for shortlisting. This ensures that your application is dealt with objectively.

Section 1 Personal and Contact Details

First Name(s):     

Last Name:     

Station/Department:     

Work Telephone:     Mobile:     

FRS Workplace Address: Correspondence Address (if different):

           

           

           

Postcode:       Postcode:      

Work Email:     

Private Email:     

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Application Ref No: (Office Use only)

Section 2Self Declaration of Eligibility

Please consider the following questions and indicate ‘Yes’ or ‘No’ as appropriate in the check boxes regarding your eligibility to apply.

Question 1

Have you achieved competence in the role of Firefighter?

Yes No

Question 2

Have you had less than 6 day’s sickness absence in the last 12 months?

Yes No

** Please attach your sickness record for the last 3 years to your completed application form.

Question 3

Is your personal record free from live misconduct/disciplinary sanctions?

Yes No

** Please attach your discipline record for the last 2 years to your completed application form.

Question 4

Are you currently under formal investigation that may result in a disciplinary process or sanction?

Yes No

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If a ‘No’ is shown to question 1, you will not be eligible to participate in the selection process.

A ‘No’ response to questions 2 or 3 or a ‘Yes’ response to question 4 will not automatically preclude you from participating, but your application may be subject to further review prior to the conclusion of the selection process.

If you believe you have extenuating circumstances in respect of your responses to questions 2, 3 or 4, which you wish to be taken into account, please complete the box below.

Rationale     

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Section 3Qualifications, Relevant Job History and Training

QualificationsEducational/vocational

qualifications Dates of education Grade (if applicable)

                 

Relevant Job HistoryRole Employer Dates of employment

                 

Relevant TrainingTitle Date Pass/Fail (if applicable)

                 

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Section 4Skills

Please indicate which of the following skills you have attained:

Core Skills Yes / No Date AchievedEFAD Yes No      

ICA Yes No      

ATACC Yes No      

Specialist Skills Yes / No Date AchievedHP Instructor Yes No      

HP Operator Driver Yes No      

HP Cage Operator Yes No      

Boat Operator Yes No      

Swift Water Technician Yes No      

Water Wading Yes No      

Animal Rescue AR1 Yes No      

Animal Rescue AR2 Yes No      

Animal Rescue AR3 Yes No      

Moffit Mounty Instructor Yes No      

Moffit Mounty Operator Yes No      

Hook Lift Operator Yes No      

PRPS Instructor Yes No      

Technical Rope Rescue Yes No      

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Section 5 Preferences – Location & Duty Systems Please indicate if you have any preference in respect of location(s)

I would prefer to work at a location within:

1. I have no preference Yes No

2. Cheshire West and Chester Yes No

3. Cheshire East Yes No

Halton and Warrington Yes No

Please indicate which duty system(s) you would be willing to work on

I would be willing to work on the following duty system(s)

Optimum Crewing Duty System Yes No

DC1 Duty System Yes No

Nucleus Yes No

I have no preference Yes No

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Section 6 Declaration of Offences

You are required to declare any convictions for offences that are not spent under the Rehabilitation of Offenders Act 1974. Include offences dealt with by a court of law, HM Services disciplinary procedures and any driving offences. This will be checked before any offer of employment is made.

Do you have any criminal convictions, which are not yet spent under the Rehabilitation of Offenders Act 1974?

Yes No

Offence:      

Date of Conviction:      /     /     

Judgement and sentence:      

Give details of any charges pending:

     

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Section 7References

Please provide two references – one of the references must be your current employer

Name:      

Title:      

Company Name:      

Address:      

Postcode:      

Telephone Number:      

E-mail Address:      

Name:      

Title:      

Company Name:      

Address:      

Postcode:      

Telephone Number:      

E-mail Address:      

Relationship to referee:       Relationship to referee:      Tick if you do not wish this person to be contacted prior to interview

Tick if you do not wish this person to be contacted prior to interview

NB: If there is any delay in receiving references this could hold up the progression of your application.

Notice Period in current primary role:      

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Section 8Evidence

In this section you are asked to provide examples of your performance/experience against the role map of a Fire Fighter.

Please consider your answers carefully having reviewed the PQA’s contained within the role map. A maximum of 200 words should be used for each answer. Once you have entered your response please insert the total word count at the end of each question.

Q1. Please give one example that demonstrates your competence in the area of Working with Others.      

# Words      Q2. Please give one example that demonstrates your competence in the area of Confidence and Resilience     

# Words      

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Q3. Please give one example that demonstrates your competence in the area of Commitment to Excellence.      

# Words      Q4. Please give one example that demonstrates your competence in the area of Commitment to Diversity and Integrity.      

# Words      Q5. Please state why you are interested in becoming a Wholetime Firefighter with Cheshire Fire and Rescue Service (in no more than 200 words)     

# Words      

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Section 9Station Manager Comment/EndorsementIn this section the Station Manager should validate (i.e. confirm accuracy of) the evidence provided within the competency based questions. They are also asked to give their rationale for endorsing or not endorsing the application and provide professional judgement regarding readiness for promotion. Appraisal ratings may be included and any other evidence that assist with an objective judgement.

Validation of Evidence within Competency Based QuestionsQuestion Comment

Q1      Q2      Q3      Q4      

Assessment of Performance in Current Role      

Station Manager RecommendationI have reviewed and evaluated all the available evidence and based on this I

Support the application Do not support the application

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Rationale for Not Supporting Application

     

Details of Station Manager completing Section 8

Name:      

Job Title:      

Department:      

Contact Telephone Number:      

Date:      

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Application Ref No: (Office Use only)

Section 10

Valuing diversity in the workplace

EQUALITY MONITORING FORM

Cheshire Fire and Rescue Service is proudly committed to equality, diversity and inclusion for all its staff and communities. Promoting equality and diversity is a Core Value at Cheshire Fire and Rescue Service and we are explicitly inclusive of all, regardless of gender, race, sexual orientation, gender identity, or disability.   We are currently the 8th best performing organisation on the 2017 Stonewall Workplace Equality Index, a Disability Confident Employer and achieved Excellence on the Fire and Rescue Service Equality Framework.  We have a number of internal staff networks (namely FirePride for LGBT colleagues and Limitless Women’s network) and more information can be found here: http://www.cheshirefire.gov.uk/about-us/equality-and-diversity/lgbt-equality

If you are happy to provide us with the following information, it will help us to make sure that our recruitment process is as inclusive as possible and will assist with our commitment to diversity. Completion of this form is optional and your responses will be kept strictly confidential. For more information on why we collect equality monitoring data, please see a copy of our monitoring leaflet which can be accessed at https://www.cheshirefire.gov.uk/Assets/1/Equality-Monitoring-Leaflet-2014.pdf and is available in hard copy on request.Please X the appropriate boxes.

I am: Female Male Prefer to Self Describe:      

Do you identify as trans?

Yes No Age: 17-24 25-35 36-45 46-55 56-65 66+ Marital Status: Single Civil Partnership Married Divorced/Separated

living together

NationalityAre you a UK citizen? YES NO

Are you an EU citizen? YES NO

If “yes”, from which country:      

If “no”, to all the above, what visa do you hold and when does this expire:     

National Insurance Number:      

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Sexual OrientationAre you:

Bisexual

Gay/Lesbian

Heterosexual/ straight

Other

Decline to state

Ethnicity - I would describe my ethnic origin as:White

British

Irish

Any other White background

Mixed

White and Black Caribbean

White and Black African

White and Asian

Any other mixed backgroundAsian or Asian British

Indian

Pakistani

Bangladeshi

Any other Asian Background

Black or Black British

Caribbean

African

Any other Black/ African/ Caribbean/ Black British background

Chinese or other Ethnic Group

Chinese

Arab

Other Ethnic Group

Other (please provide details)      

Gypsy and Traveller

Romany/Roma Gypsy

Other

Irish Traveller

Other (please provide details)      

prefer not to say

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Religious Belief/FaithAre you:

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Other

None

Decline to state

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Equality Act 2010

In accordance with the Equality Act 2010 we are asking the question at the bottom of this page to ensure that all applicants who are disabled receive the appropriate support and reasonable adjustments and to monitor all aspects of our recruitment process.

Below are the four parts to the definition of someone who is classed as disabled under the Act.

1. A disabled person is someone who has a physical or mental impairment.Physical impairment includes hearing and visual impairments and conditions such as diabetes, dyslexia, severe disfigurement, heart conditions and epilepsy. Some conditions which may develop over time (specifically cancer, HIV or AIDS, or multiple sclerosis) will automatically be classed as disability from the day they are diagnosed. Mental impairment Mental impairment includes learning disabilities and mental illnesses, such as autism, depression or PTSD. New paragraph: People whose impairments are controlled, corrected or adjusted by medication or aids are covered by the Equality Act 2010 as are those who have had a disability in the past but have since recovered.

2. The impairment has got to last, or be expected to last, at least 12 months. a person with a broken leg who is only temporarily disabled would not be covered. a person who has had an impairment, which may happen again, is covered.

3. The impairment must have a substantial and long term adverse effect. This may be obvious in the time it takes someone to carry out a task or in the way he/she carries out

the task.

4. The impairment must affect the person’s ability to carry out normal day-to-day activities. These include mobility; manual dexterity; physical co-ordination;

continence; ability to lift or carry objects; speech, hearing or sight; memory or ability to concentrate, learn or understand.

Do you consider yourself to be disabled as defined above? YES NO

Thank you for completing this form.All information is strictly confidential and shall only be used for the purpose

of employment equality monitoring.

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Section 11DeclarationI declare that:

The information given in this application and supporting forms are true and correct.

I understand that False or misleading information given may disqualify my application or

render any contract of employment liable to termination without notice.

I understand that

There is no relocation assistance available if I am successful in securing a wholetime firefighter position with Cheshire Fire and Rescue Service.

I confirm that I have completed this application form and that to the best of my knowledge the information I have provided in it is true, accurate and correct.

Signed:       Date:      

Please note: Approaching any elected councillor or employee of the Cheshire Fire Authority directly or indirectly to promote this application or providing false/misleading information in this form shall disqualify you from appointment or if appointed may render you liable to disciplinary action, which could lead to your dismissal.

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Section 12Availability

Stage 1 – Interview and Operational AssessmentIf you are shortlisted following submission of your application you will be invited to Stage 1 of the selection process, which will take place on either 27h or 28th

February 2018. The interview & assessment will be completed within 1 day.We would ask that all shortlisted candidates make every effort to be available to participate in the process on one of the assigned dates. However, if you have prior commitments that will mean you are unavailable on all three dates above please declare these below.

                                 

Submission of applications

Please email your completed form including:

Portfolio of Evidence Sickness Record for last 3 years Disciplinary Record for last 2 years

to recruitment@cheshirefire.gov.uk by 22nd January 2018 5pm

Note;

Any applications received after the closing date will not be considered. Incomplete applications will also be excluded from the selection process.

All Personal Details and Equal Opportunities Monitoring Information will not be used as part of the selection process. It is for monitoring purposes only.

Please note it is the responsibility of the applicant to plan accordingly and ensure that the form is submitted on time with all of the necessary management

endorsement sections completed. Incomplete applications will not be considered within the selection process.

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