ORANGE TREE THEATRE Ltd

1 Clarence Street, Richmond, Surrey TW9 2SA

APPLICATIONFORM

Please complete

Post Applied for: Development Officer
Closing date: Monday 11 July 2016, 10am

SECTION ONE: PERSONAL DETAILS

Surname:
First Name(s):
Evening telephone number:
Mobile number :
Home address:
Email address:

YOU MAY ATTACH YOUR OWN CV, BUT PLEASE ALSO FILL IN THE APPLICATION FORM BELOW. Boxes will expand as you type.

Employment Experience

Year / Employer / Post

Education, Training and Professional Development

Dates / school/university/organisation / course/qualification

Supporting statementwhich should cover the following:

  • What has attracted you to this post
  • How do your skills and experience match the job description and person specification

Box will expand as you type

REFERENCES

Please give the name and address of two referees. Where possible, one referee should be your present or most recent employer.

Referee name:

Organisation/Address:

Phone number:

Email address:

Occupation:

How are you known to referee?

May we request this reference: at any time / only after offer of employment

(Please delete)

Referee name:

Organisation/Address:

Phone number:

Email address:

Occupation:

How are you known to referee?

May we request this reference: at any time/only after offer of employment? (Please delete)

ADDITIONAL INFORMATION

Do you require any reasonable adjustments, due to a disability or health condition, to enable you to attend an interview, or which you wish us to take into account when considering your application?

Yes / No (please delete)

DISABILITY DISCRIMINATION ACT 1995

Do you have any special needs which might require The Orange Tree Theatre to make reasonable changes in order for you to undertake this job?

Yes / No (please delete)

If Yes, please provide further details:

HEALTH

How many days were you absent through ill-health in the past 2 years:

Please give details of any illness which caused you to be absent for 10 or more consecutive days during the last two years

REHABILITATION OF OFFENDERS ACT 1974 (AS AMENDED)

Please give details of any criminal convictions you have had, excluding any considered ‘spent’ under The Rehabilitation of Offenders Act 1974 or minor motoring offences

ASYLUM AND IMMIGRATION ACT 1996

Please confirm that you have the right to work in this country Yes /No

Do you require a work permit to work in this country? Yes / No

If Yes please give more details:

DATA PROTECTION

I agree that the information given in my application may be used for purposes registered under the Data Protection Act 2003, and I consent to the information being stored on manual and computerised files for relevant employment-related purposes.

DECLARATION

I confirm that the information I have given in my application is accurate and correct to the best of my knowledge. I consent to The Orange Tree Theatre checking any of the details I have given. I understand that the supply of inaccurate or incorrect information, or omission of any material information from my application,may result in the withdrawal of any offer of employment, or termination of employment.

Name of candidate:Date:

EQUAL OPPORTUNITIES MONITORING

SELF-CLASSIFICATION FORM

Monitoring

The information provided in this section is for monitoring purposes only. This information will be kept securely and will not be made available to anyone before or during shortlisting. It will not be used in deciding whether to shortlist you for interview or offer you employment.

1. Are you

( )Female( ) Male

2. Which age range do you fall into

( )( )( )( )( )( )

16–1920-2930-3940-4950-5960 or over

3. Ethnic origin

Please tick the appropriate box to indicate the group with which you identify.

A.White

( )British

( )Any other White background, please state: ……………………..

B.Asian or Asian British

( )Asian Bangladeshi

( )Asian Indian

( )Asian Pakistani

( )Any other Asian background, please state: ……………………….

C.Black or Black British

( )African

( )Caribbean

( )Any other Black origin, please state: ………………………………

D.Chinese or other ethnic group

( )Chinese

( )Any other origin, please state ……………………………………….

E. Mixed Heritage

( )Asian and White

( )Black African and White

( )Black Caribbean and White

( )Any other mixed heritage origin, please state: ……………………

4. Do you consider yourself to have a disability

( ) Yes ( )No

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