The British Institute of Radiology

THE BRITISH INSTITUTE OF RADIOLOGY

JOB APPLICATION FORM

POST APPLIED FOR: Education Development Manager

Please carefully complete each section of the form in black ink or typescript. Please complete all questions as fully as possible. We undertake short listing based only on the information on the form.

A. PERSONAL DETAILS
Surname: ______First Names: ______Title: ______
Other surnames you have been known by: ______
Address: ______
______Post code: ______
Home : ______Work : ______
Mobile :______Email address: ______

B. PRESENT OR MOST RECENT EMPLOYMENT

Employer: ______
Address: ______
______: ______
From: ______To: ______Salary: £______
Job Title: ______
Main responsibilities: ______
______
______
______
Notice Period: ______Reason for Leaving: ______

C. EMPLOYMENT HISTORY

Please give details of all previous employment starting with the most recent (including periods of unemployment). If you are still in full time education, please give details of any vacation or part time employment. The information given may be used to obtain references at a later date.

Employer / Employed from / Employed to / Position held, duties and reasons for leaving
Full name and Address
: / __ / __ / __ / __ / __ / __
Full name and Address
: / __ / __ / __ / __ / __ / __
Full name and Address
: / __ / __ / __ / __ / __ / __
Full name and Address
: / __ / __ / __ / __ / __ / __
Full name and Address
: / __ / __ / __ / __ / __ / __

Please continue on a separate sheet using the same format if necessary.

Job Application Form_1.0Page 1 of 8

23 June 2009 Owner: General Secretary

The British Institute of Radiology

D. EDUCATION AND QUALIFICATIONS

Starting with the most recent:

Secondary/Further

School / College or University / Subject or Course / Examination e.g GCSE / Grade

Membership of Professional Organisations / Bodies

Date / Membership and Level

Relevant Training Courses Attended

From / To / Training Provider / Course Title

E. SUPPORTING STATEMENT

In this section you must give full details of how your skills, abilities and experience match the person specification of the post that you are applying for. Please address each point in the person specification which is marked for shortlisting. Be concise in your answers, but give evidence – it is not sufficient to simply duplicate the person specification. You can give evidence based on any experience – paid or voluntary work, personal or academic life. We draw up the short list on the basis of how each applicant’s skills, abilities and experience match the person specification.

Please continue on a separate sheet if necessary (you may also append a CV if you wish).

F. REFERENCES

Please give the details of two referees who can verify your employment record and give information about your suitability for this post. References must include one current and one previous employer (if not in employment two previous employers). If you have not been in paid employment, one reference must be from a school/college/university and one from someone who can comment on your ability to meet the requirements of the job.

Name:
Job Title:
Address:
Tel:
Fax Number:
Email Address:
Capacity in which they know you: / Name:
Job Title:
Address:
Tel:
Fax Number:
Email Address:
Capacity in which they know you:

G. SICKNESS ABSENCE RECORD

Please give details of absences from work due to sickness within the last two years.

Start Date / End Date / Duration in working days / Reason for absence

H. RIGHT TO WORK IN THE UK

The BIR is legally obliged to ensure that all staff it recruits have the right to work in the UK.

Do you have the right to work in the UK?

Yes No

Note – if you are offered the post, we will require you to produce documentation concerning your right to work in the UK.

I. DISCLOSURE OF CRIMINAL RECORD

All candidates for posts are required to disclose details of unspent criminal convictions. The BIR takes a positive attitude to ex-offenders and will only take the criminal record into account if considered relevant to the job. Any information on criminal offences will be treated in strict confidence.

Please answer the following question:

Do you have any unspent criminal convictions, cautions or bind-overs?

YesNo

If yes, you will be given the opportunity to explain the circumstances of the conviction, if you are shortlisted for interview.

J. RELATIVES

Are you related to an employee or Trustee of the Institute? YesNo

If yes, please give details: ______

______

K. DISABILITY ADJUSTMENTS

Do you consider yourself to have a disability/impairment covered by the Disability Discrimination Act 1995?

Yes No

If yes, is there anything we need to know in order to offer you a fair selection process?

Please give details ______

L. PLEASE READ THE FOLLOWING DECLARATION CAREFULLY BEFORE SIGNING THIS FORM

I declare that the information given in this application is to the best of my knowledge complete and correct. I understand that the British Institute of Radiology reserves the right to seek verification of any information provided. I understand that if it is discovered that I have given false information I may be dismissed from the BIR’s employment or any job offer may be withdrawn.

I agree to the BIR using the information contained in this form for the proper administration of the recruitment process and should I be successful I agree that the information will be used as part of the employment relationship. I understand that in using this information, the BIR will complywith the Data Protection Act 1998.

Signature...... Date...... …......

Name (Print)...... ………………………………………......

Please now return this application form, plus the monitoring form below, to:

Jennifer Edie, British Institute of Radiology, 48-50 St John Street, London EC1M 4DG or

M . EQUALITY OF OPPORTUNITY MONITORING FORM

In order to monitor the effectiveness of our Equal Opportunities Policy, we request that all applications provide the following information, which will be treated as confidential. This information will not be used in any part of the recruitment process other than for statistical monitoring. It will be detached from your application prior to shortlisting.

Job Title of post you are applying for: ______

Your Full Names: ______

Date of Birth:______Gender: Male Female

I would describe my race or ethnic origin as: (Please √ one)

Asian or Asian British
 Bangladeshi
 Indian
 Pakistani
 Any other Asian background / Mixed
 White and Asian
 White and Black African
 White and Black Caribbean
 Any other Mixed background
Black or Black British
 African
 Caribbean
 Any other Black background / White
 White British
 Irish
 Any other White background
Chinese or other ethnic group
 Chinese
 Any other:
Please specify: ______

Do you consider yourself to have a disability as defined by the Disability Discrimination Act 1995.

√ Yes No

To help us monitor our advertising, please state where you saw this post advertised:

√ Newspaper advert someone told me about the vacancy

referral from agency BIR website

Other, please specify:

Job Application Form_0.1Page 1 of 8

23 June 2009 Owner: General Secretary