Work Application Form Step 1 of 3 33% Applying Position or Job Reference*Where did you hear about the position?What type of position are you applying for?*English Language Teacher or Academic Manager RoleELT Trainer or Similar RoleNursery Practitioner or Nursery Manager RoleAll Other PositionsDo you require a permit to work in the UK?*YesNoDo you have a current permit to work?*YesNoWhat date does your permit expire?* Day Month Year Personal DetailsName* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Date of Birth* Day Month Year Email* Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile Phone Number*Home Phone Number SafeguardingHave you ever been convicted of any criminal offence?*YesNoRequired under Rehabilitation of Offenders Act 1974Please give details of the conviction(s) and the date(s)*Safeguarding Declaration* I declare I am fit to be working with students under the age of 18 or vulnerable adults. As part of our safeguarding policy for young learners and vulnerable adults, you must declare that you are not unfit to be working with students under the age of 18 or vulnerable adults in order to be considered a position. Do not progress further unless you can can make this declaration.Do you have a valid Disclosure and Barring Service?*YesNoDisclosure NoPlease provide us with your DBS disclosure number, if you don't have this information at hand you will be asked for it before able to start work.Disclosure Cleared Date Day Month Year When was the date that your last DBS check was cleared? if you don't have this information at hand you will be asked for it before able to start work.DBS or Police Check* I agree to DBS or police check if my job role requires Depending on the job role you are applying for you may be asked to obtain a Police CheckChildcare Act DisclosureAs we accept children under the age of 8, we ask staff, including homestay hosts who accept children under 8, to answer the following questions regarding situations involving looking after children which would not appear on a DBS check but would be areas of concern for us.Have you ever had a child placed under a Care Order?*YesNoHave you ever had a Childcare Registration cancelled?*YesNoHave you ever been convicted of any offence against a child?*YesNoDisqualification by Association* I hereby declare that I do not 'live or work in the same household' as someone who is barred from working with children or young people. As part of our safeguarding policy for young learners and vulnerable adults, you must declare that you do not 'live or work in the same household' as someone who is barred from working with children or young people.HealthHave you ever been diagnosed with any of the following? 1. Blackouts/loss of consciousness/giddiness 2. Disorder of the nervous system 3. Psychiatric problems (eg. anxiety, stress, depression, phobias) 4. Disease of the heart or blood vessels/raised blood pressure 5. Diabetes 6. Skin problem 7. Asthma, bronchitis, pneumonia or other chest complaint 8. Visual/hearing problems 9. Musculoskeletal disorders (eg back pain, arthritis, rheumatoid arthritis, difficulty in bending/lifting/sitting for prolonged periods) 10. Are you at present taking any injections, pills drugs, or other medication? 11. Have you had any other diseases, disabilities or long term medical conditions? 12. Have you had any time off work for medical reasons in the last two years? 13. Have you ever had a disability or industrial injury benefit claim? * 14. Do you have any particular requirements regarding interview or other selection arrangements? 15. Are you registered disabled? *Under the Disability Discrimination Act 1995, a disability is defined as a physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities such as those involved in mobility, manual dexterity, physical co-ordination, speech, hearing, eye sight or communication, or a permanent condition which is controlled by medication. If “YES” to any of above please detail briefly below. CV Upload*Max. file size: 6 MB.Please upload your CV here.Declaration* I confirm the information given in this form is correct and that misleading statements may be sufficient grounds for cancelling any agreements made. To meet our obligations under the Data Protection Legislation all candidates accept that by submitting their application form all or part of the information provided on this form may be used and processed by KKCL for recruitment and personnel administration and for equality monitoring. Such use will be subject to the provisions of the Data Protection Act 1998. Δ