Graduate-entry Internship Programme

University Liaison Officer

Application Form

Please return this form and the equal opportunities form to y 12 noononThursday, 24thFebruary 2011. The first round of the selection process will take place on Thursday, 3rd March 2011atIntoUniversity Lambeth, Cottington Street, London, SE11 4RZ and, if successful, the second round will take place on Thursday, 10th March 2011 at Imperial College (Outreach Office), South Kensington, London SW7 2AZ. Please note this is where the successful candidate will be based for the duration of the internship.
This application form must be completed in all sections – C.V.s are not an acceptable alternative. TYPED APPLICATIONS ONLY PLEASE. Thank you! Please reformat the form to fit the information you input.
Thank you for your interest in us and for taking the time to complete this application form. Owing to the anticipated volume of response we regret that we cannot reply to every application. If you do not hear from us within a month of the closing date, you may assume that you have not been selected for interview on this occasion.
Personal Information
Surname: / Other Names:
Title: (Mr/Ms) / Previous Names:
Contact Address:
Tel (home): / Tel (mobile):
Email address: / NI Number:
Do you require a work permit or visa to take up this internship opportunity? YES/NO
Availability: (please think carefully about your availability and note that all applications will be considered equally)
I am available from 21st March 2011 for 3 4 5 6 months (please underline one)
I am available for 2 3 days a week (please underline one)
Most Relevant Experience
(paid or voluntary acceptable)
Job title/ voluntary position:
Name of employer/place of volunteering:
Address:
Date appointed: / Date of leaving (if applicable):
Salary (if relevant): / Reason for leaving:
Please use this box to tell us about the duties, responsibilities and challenges of your most relevant paid or voluntary experience
Education and formal training starting with secondary school
If shortlisted, we will request proof of any qualifications held
Dates / School, College, University / Course/Subjects / Qualifications with grades & date awarded
Other Previous Employment (Paid or Voluntary)
Dates / Name of Employer/ Voluntary Organisation / JobTitle/Key tasks / Reason for leaving
Supporting Statement
In approximately 500 words (please do not exceed the word limit by more than 10%) please use this section to tell us WHY you are applying for this internship and HOW you feel you could meet the requirements of the role. Please use this section to demonstrate any skills, experience, achievements, knowledge, personal qualities that you feel are relevant. This could include voluntary work, leisure interests and any other activities which you consider relevant to this position. Please comment on any experiences you have of volunteering, administration, university and the charity sector. Also we would like to hear a practical example of your ability to undertake tasks independently without close supervision.
References
Please provide names, addresses, telephone numbers and email addresses for two referees who have knowledge of you in a working environment (paid/voluntary) and/or an appropriate academic referee. We will contact your referees on successful application.
Name: / Name:
Position/Relationship: / Position/Relationship:
Address: / Address:
Email: / Email:
Tel: / Tel:
Where did you see this post advertised? Please circle more than one if applicable.
CharityJobs.co.uk University Careers Service IntoUniversity website
Other (please state where)
Do you have any unspent convictions under the terms of the Rehabilitation of Offenders Act (1974)?
Yes / No
If you answered Yes, please provide further details:
Please Note: You will be subject to an enhanced CRB check if offered a position and your appointment will be withdrawn if your CRB check is not satisfactory.

DECLARATION

I declare that the information I have supplied on this form is true and accurate.

Signature: Date:

(If you are selected for interview you will be required to sign a hard copy of this form on the interview day).

CLOSING DATE: Thursday, 24th February 2011, 12 noon

SELECTION DATES:Thursday, 3rd March and Thursday, 10th March 2011

Please do not apply for this post if you are not available onthe selection date. We are sorry but we are unable to provide alternative dates.

This form is to be returned to .

We would be grateful if you would fill in and return the Equal Opportunities monitoring form (below) along with your application form.

Equal Opportunities Monitoring Form

Strictly Confidential

To help us ensure that our recruitment procedures operate in such a way as to provide genuine equality of opportunity, and for no other reason, it would be helpful if you would assist this process by completing the brief questions below and return this sheet with your application form. This information will not be available to members of the selection panel.

Please answer the following questions:

Post : Graduate-entry Internship Programme –University Liaison Officer

Sex:

Age:

Do you consider yourself disabled?:

Ethnic Origin:

Asian or Asian British – Bangladeshi, Indian, Pakistani or Other

Mixed – White and Asian, White and Black African, White and Black Caribbean or Other

Black or Black British – African, Caribbean or Other

White –British, Irish or Other

Chinese

Other

Thank you for your time.