Fillable Application Form (Mid and West Wales Fire and Rescue Service)

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Application Form (Mid and West Wales Fire and Rescue Service)

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FFURFLEN GAIS AM SWYDD | JOB APPLICATION
Darllenwch y nodiadau canllaw cyn llenwi’r urflen hon
Please read the guidance notes before completing this form
Teitl y Swydd | Job Title:
...............................................................................................
Cyf | Ref:
................................................
Adran | Department:
............................................................................................................................................................................
Lleoliad | Location:
..............................................................................................................................................................................
.......................................................................................................................................................................................................................
Cyfenw | Family Name:
........................................................................................................................................................................................
Enwau Cyntaf | Forenames:
..............................................................................................................................................................................
Cyfeiriad | Address:
..............................................................................................................................................................................................
..........................................................................................................................................................................................................................................
...........................................................................................................................................................
Côd post | Postcode:
.....................................
Rhif ôn yn ystod y dydd | Daytime Telephone number(s):
................................................................................................................
Rhif ôn gyda’r nos | Evening Telephone Number:
.................................................................................................................................
Rhif ôn symudol | Mobile Telephone Number:
.......................................................................................................................................
E-bost | Email:
..........................................................................................................................................................................................................
A allwch chi gadarnhau nad ydych chi’n ddarostyngedig i reolaeth fewnfudo
(ei bod yn ofynnol i chi gael caniatâd i ddod i mewn neu i aros yn y DU)? Gallaf Na allaf
Can you confirm you are not subject to immigration control
(require leave to enter or remain in the UK)? Yes No
A oes gennych chi hawl i breswylio yn y DU? Oes Nac oes
Do you have the right to residency in the UK? Yes No
Ydych chi’n rhydd i aros a derbyn gwaith yn y DU? Ydw Nac Ydw
Are you free to remain and take up employment in the UK? Yes No
MANYLION PERSONOL | PERSONAL DETAILS
Cwblhewch mewn priflythrennau os gwelwch yn dda / Please complete in capitals
JR0345
Adeiladu cymunedau mwy diogel | Building safer communities
CANOLWYR | REFEREES
Enwau a chyfeiriadau dau berson y gallwn gael geirda ganddynt, a dylech gynnwys eich
cyflogwr presennol fel un ohonynt, os yw’n bosibl.
Names and addresses of two persons to whom reference may be made and one, if possible,
should be a present employer.
SWYDD BRESENNOL | PRESENT APPOINTMENT
Enw | Name:
.................................................................................
Sefydliad | Organisation:
........................................................
Cyfeiriad | Address:
..................................................................
..............................................................................................................
Côd post | Postcode:
................................................................
Rhif Ffôn | Phone:
......................................................................
E-bost | Email:
.............................................................................
A gawn ni gysylltu â’r canolwr nawr?
Cewch Na chewch
May we contact the referee now?
Yes No
Enw | Name:
.................................................................................
Sefydliad | Organisation:
........................................................
Cyfeiriad | Address:
..................................................................
..............................................................................................................
Côd post | Postcode:
................................................................
Rhif Ffôn | Phone:
......................................................................
E-bost | Email:
.............................................................................
A gawn ni gysylltu â’r canolwr nawr?
Cewch Na chewch
May we contact the referee now?
Yes No
Nid yw geirda a gyflwynir gan aelodau o’r Awdurdod Tân yn dderbyniol.
D.S. Nid oes angen i ymgeiswyr mewnol ddarparu geirda.
References submitted by Members of the Fire Authority are not acceptable.
N.B Internal applicants need not supply references.
Enw a Chyfeiriad y Cyflogwr | Employer Name and Address:
.........................................................................................................
..........................................................................................................................................................................................................................................
Enw’r Swydd | Job Title:
.......................................................................................................................................................................................
Dyddiad Cychwyn | Date of Commencement:
..........................................................
Cyflog | Salary:
............................................
Hysbysiad Gadael Gofynnol | Notice Required:
......................................................................................................................................
Disgrifiad Cryno o’r Swydd/Swyddogaeth | Brief Job Description/Role:
Adeiladu cymunedau mwy diogel | Building safer communities
SWYDDI BLAENOROL | PREVIOUS APPOINTMENTS
gan gynnwys dyddiadau a chyflog | with dates and salary
ADDYSG | EDUCATION
O - Hyd at
From - To
Prifysgol, Coleg, Ysgol ac ati
University, College, School etc
Arholiadau a gwblhawyd yn llwyddiannus
Examinations passed
Gradd
Grade
Dylech atodi tudalennau ychwanegol at y urflen hon os oes angen | Additional sheets should be attached if necessary
Enw a Chyfeiriad y Cyflogwr
Employer Name and Address
Y Rheswm dros Adael
Reason for Leaving
Enw’r Swydd
Job Title
Cyflog
Salary
Adeiladu cymunedau mwy diogel | Building safer communities
CYMWYSTERAU PROFFESIYNOL | PROFESSIONAL QUALIFICATIONS
IEITHOEDD | LANGUAGES
Ticiwch y blwch sydd, yn eich tyb chi, yn cyfateb orau i’ch sgiliau yn yr ieithoedd a nodir.
Please tick the box for each language that you think best demonstrates your ability.
A fyddai’n well gennych wneud yr asesiadau sy’n ofynnol fel rhan o’r broses dethol am y swydd yma:
yn Gymraeg yn Saesneg
Would you prefer to conduct the assessments required as part of the selection process for this post in:
Welsh English
Os byddai’n well gennych gynnal eich cyfweliad yn y Gymraeg, ac os na all y Gwasanaeth gynnull panel Cymraeg
ei iaith ar yr adeg honno, byddwn yn trefnu i gyfieithydd ar y pryd fod yn bresennol.
Should your preference be to conduct your interview in Welsh, and the Service is unable to convene a Welsh
speaking interview panel at that time, we will arrange for a simultaneous translator to be present.
Lefel
Level
Dim | None
Dysgwr | Learner
Canolradd | Intermediate
Rhugl | Fluent
Cymraeg
Welsh
Saesneg
English
Cymraeg
Welsh
Saesneg
English
Cymraeg
Welsh
Saesneg
English
Siarad | Speaking Ysgrifennu | Writing Darllen | Reading
Adeiladu cymunedau mwy diogel | Building safer communities
MANYLION YNGHYLCH EICH PROFIAD A DATGANIAD I GEFNOGI EICH CAIS
EXPERIENCE AND STATEMENT IN SUPPORT OF YOUR APPLICATION
Rhaid cwblhau’r adran hon - nid yw’n ddigon i gyfeirio at CV.
Dylech atodi tudalennau ychwanegol at y urflen hon os oes angen.
This section should be completed - it is not suicient to refer to a CV.
Additional sheets should be attached if necessary.
Adeiladu cymunedau mwy diogel | Building safer communities
GWYBODAETH YCHWANEGOL | ADDITIONAL INFORMATION
EUOGFARNAU (DEDDF AILSEFYDLU TROSEDDWYR 1974)
CONVICTIONS (REHABILITATION OF OFFENDERS ACT 1974)
DATGANIAD | DECLARATION
Ydych chi’n perthyn i Gynghorydd neu Aelod o Sta Gwasanaeth Tân ac Achub Canolbarth a Gorllewin Cymru
(rhowch fanylion os ydych)?
Are you related to a Councillor or Employee of the Mid and West Wales Fire and Rescue Service
(if yes give details)?
Odan y ddeddf uchod, gellir ystyried y rhan fwyaf o ddedfrydau a ddyfernir gan Lys Barn ar gyfer tramgwyddau
troseddol fel rhai sydd wedi darfod a’u diystyried, ar gyfer y rhan fwyaf o ddibenion, ar ôl cyfnod penodol o amser
ac nid oes angen eu datgelu. Fodd bynnag, os yw’r swydd yr ydych wedi gwneud cais amdani yn ddarostyngedig
i Orchmynion Deddf Ailsefydlu Troseddwyr (Eithriadau), mae’n ofynnol i chi ddatgelu unrhyw euogfarnau
troseddol ac mae’n bosib y gwneir ymholiadau ac archwiliadau yn y cyswllt hwnnw. Eich cyfrifoldeb chi yw
gwahaniaethu rhwng yr euogfarnau hynny sy’n rhaid eu datgelu a’r rheiny nad oes angen eu datgelu ac mae’n
bosib y gwneir ymholiadau ac archwiliadau yn y cyswllt hwnnw.
Under the above Act, most sentences awarded by a Court for criminal oences may be regarded as spent and
disregarded, for most purposes, after a specified period of time and need not be disclosed. However, if the
appointment for which you have applied is one to which the Rehabilitation of Oenders Act (Exceptions) Orders
apply, you are required to declare any criminal convictions and enquiries and checks may be made in that respect.
It is your responsibility to distinguish between those convictions, which require to be declared and those that do
not and enquiries and checks may be made in that respect.
Unrhyw euogfarnau i’w datgelu |
Any convictions declared: Oes Nac oes | Yes No
Os OES, nodwch os gwelwch yn dda | If YES please state:
Rwy’n cadarnhau bod y datganiadau a wneir ar y urflen gais hon yn wir ac yn gywir hyd eithaf fy ngwybodaeth
a’m cred, ac nid wyf yn gwybod am unrhyw amgylchiadau a allai, petaent yn hysbys, neu’n dyfod yn hysbys, i’r
Awdurdod Tân, achosi iddynt amau fy addasrwydd ar gyfer fy mhenodi.
I declare that the statements made in this application form are true and accurate to the best of my knowledge and
belief, and I am not aware of any circumstances which if known, or become known, to the Fire Authority, might
cause them to question my suitability for appointment.
Llofnod | Signature:
........................................................................
Dyddiad | Date:
...........................
A oes gennych drwydded yrru gyfredol? Oes Nac oes
Do you hold a current driving licence? Yes No
Adeiladu cymunedau mwy diogel | Building safer communities
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EQUAL OPPORTUNITIES EMPLOYMENT POLICY
Mid and West Wales Fire and Rescue Service is committed to ensuring equal opportunities in the Fire Service regardless
of age, gender, religion, sexual orientation, marital status, ethnic origin and disability and promotes a policy of full equality
of opportunity for employment and advancement in accordance with all relevant legislation.
In order to monitor the eectiveness of our policies it is necessary to know about the people who apply to join the service,
we would therefore be grateful if you would complete the questionnaire below.
Please be assured that the information you supply will be treated in strictest confidence and will be used for statistical
purposes only and will not be available to Oicers during the selection/screening process. This information will be used
only for statistical record purposes and will not be made available outside the Human Resources Department.
PERSONAL DETAILS please complete in capitals
PARTNERSHIP STATUS
DATE OF BIRTH AND GENDER
White
British
Irish
Other white background*
*Please specify:
.................................
Asian or Asian British
Indian
Pakistani
Bangladeshi
Other Asian background*
*Please specify:
..................................
Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background*
*Please specify:
...........................................
Chinese or Other Ethnic Group
Chinese
Other Ethnic Group*
*Please specify:
...........................................
Black or Black British
Caribbean
African
Any other Black background*
*Please specify:
.........................................
ETHNIC ORIGIN (for statistical purposes only)
Single Married Separated Divorced Civil Partner Other (please specify):
............................
Family Name:
........................................................................................................................................................................................
Forenames:
.........................................................................
Title:Dr/Mr/Mrs/Miss/Ms/Other
............................................
Post applied for:
.......................................................................................................................................
Ref:
..................................
Where did you see this position advertised?:
........................................................................................................................
Date of Birth:
.........................................
Gender please specify:
...............................................................................................
If you wish, you may disclose information about yourself in this section about your:
Religion:
...................................................................................................................................................................................................
Sexual orientation: Heterosexual Bisexual Lesbian Gay Prefer not to state
DISABILITY
Disability: We use the following definition of disability: ‘A physical or mental impairment which has a long-term
adverse eect on your ability to carry out normal day-to-day activities.’
We guarantee to interview disabled people who meet all of the essential criteria for the post.
Do you consider yourself to be a disabled person? Yes No
If yes, is there any support or assistance that you would need at a job interview? Please indicate here, or contact
the Human Resources Department.
................................................................................................................................................................
Adeiladu cymunedau mwy diogel | Building safer communities
POLISI CYFLOGAETH CYFLE CYFARTAL
Mae Gwasanaeth Tân ac Achub Canolbarth a Gorllewin Cymru yn ymrwymedig i sicrhau cyfle cyfartal yn y Gwasanaeth
Tân heb ystyried oedran, rhyw, tueddfryd rhywiol, statws priodasol, tarddiad ethnig nac anabledd, ac mae’n hyrwyddo
polisi cyfle cyfartal llawn ar gyfer cyflogaeth a dyrchafiad yn unol â phob deddfwriaeth berthnasol.
Er mwyn monitro pa mor eeithiol yw ein polisïau, mae angen i ni wybod am y bobl sy’n gwneud cais i ymuno â’r
gwasanaeth, ac felly byddem yn gwerthfawrogi pe byddech chi’n cwblhau’r holiadur isod.
Gellwch fod yn sicr y cedwir yr wybodaeth a ddarperir gennych yn hollol gyfrinachol a’i defnyddio at bwrpasau ystadegol
yn unig ac ni fydd ar gael i Swyddogion yn ystod y broses ddethol/sgrinio. Defnyddir yr wybodaeth hon at ddibenion
cofnodi ystadegol yn unig ac ni fydd ar gael y tu allan i’r Adran Adnoddau Dynol.
MANYLION PERSONOL Cwblhewch mewn priflythrennau os gwelwch yn dda
STATWS PARTNERIAETH
TRAS ETHNIG (at ddibenion ystadegol yn unig)
Sengl Priod Wedi gwahanu Wedi ysgaru Partner Sifil Arall (noder):
............................
ANABLEDD
Anabledd: Rydym yn defnyddio’r diiniad canlynol o anabledd: ‘Diyg cororol neu feddyliol sy’n cael eaith
andwyol hirdymor ar eich gallu i wneud gweithgareddau arferol o ddydd i ddydd.’Rydym yn gwarantu y byddwn
yn rhoi cyfweliad i bobl anabl sy’n bodloni’r holl feini prawf hanfodol ar gyfer y swydd.
Ydych chi’n ystyried eich hun fel bod yn berson sydd ag anabledd? Ydw Nac ydw
Os ydych yn anabl, a oes unrhyw gynhorthwy neu gymorth y byddech eu hangen mewn cyfweliad am swydd?
Byddwch gystal â chrybwyll hyn yma neu cysylltwch â’r Adran Adnoddau Dynol.
..................................................................
Gwyn
Prydeinig
Gwyddelig
Cefndir Gwyn arall*
*Rhowch fanylion:
...................................
Asiaidd neu Asiaidd Prydeinig
Indiaidd
Pacistanaidd
Bangladeshi
Cefndir Asiaidd arall*
*Rhowch fanylion:
...................................
Cymysg
Gwyn a Du Caribïaidd
Gwyn a Du Aricanaidd
Gwyn ac Asiaidd
Cefndir Cymysg arall*
*Rhowch fanylion:
...........................................
Tsieineaidd neu Grwp Ethnig Arall
Tsieineaidd
Grwp Ethnig arall*
*Rhowch fanylion:
...........................................
Du neu Ddu Prydeinig
Caribïaidd
African
Cefndir Du arall*
*Rhowch fanylion:
.....................................
ˆ
ˆ
Adeiladu cymunedau mwy diogel | Building safer communities
DATE OF BIRTH AND GENDER
Cyfenw:
....................................................................................................................................................................................................
Enwau Cyntaf:
...............................................................................
Teitl: Y Dr/Mr/Mrs/Miss/Ms/Arall
...............................
Swydd yr ymgeisir amdani:
...........................................................................................................................
Cyf:
.......................
Ym mhle y gwelsoch hysbyseb am y swydd hon?:
.............................................................................................................
Dyddiad Geni:
..............................
Rhyw (rhowch fanylion):
....................................................................................................
Os ydych yn dymuno, gallech ddatgelu gwybodaeth amdanoch eich hunan yn yr adran hon am eich:
Crefydd:
...................................................................................................................................................................................................
Tueddfryd rhywiol: Heterorywiol Deurywiol Lesbiad Hoyw Ddim am ddweud
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Application Form (Mid and West Wales Fire and Rescue Service)

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Completed 18 July 2020

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