Application Form Finest Sensory Assessment Panel

APPLICATION FORM

SENSORY FOOD ASSESSMENT PANEL

Personal Details

Miss / Mrs / Ms / Mr (delete as appropriate)

First Name (s) ……………………………………… Surname …………………………………………

Present Address ………………………………………………………………………………………………

………………………………………………………………………………………………

Postcode ………………………………………………………………………………………………

Date of Birth ………………………………………………………………………………………………

Email : ………………………………………………………………………………………………

Telephone Number (Home)………………………………………………………… ………………………

(Work or Mobile) ………………………………………………………………………

Tesco Clubcard Number ……………………………………………………………………………………

Do you have any food allergies? YES / NO

Please give details

………………………………………………………………………………………….……………………

Do you wear a dental plate? YES / NO

Are you colour blind? YES / NO

Do you take any medication that affects your taste and smell? YES / NO

Are you a Vegetarian YES / NO

Do you suffer from Diabetes YES / NO

Do you suffer from Hypertension YES / NO

Current Position

Are you currently employed? YES / NO

If yes, please give details of your current employer, the date you joined them and your position/role:

…………………………………………………………………………………………………………………

Do you have any family members in the Food Industry? YES / NO

If yes, please give details: ………………………………………………………….………………………

…………………………………………………………………………………………………………………

Are there any food products within each product category you WOULD REFUSE to eat?

Please list any products within this category you would refuse to eat?
Bakery - bread, cakes (fruit pies, sponges, tarts)
Fruit, Salad & Vegetables
Meat, Fish & Poultry
Dairy & Eggs (butter, yoghurt, cheese)
Sausages, Bacon & Cooked meats
Ready Meals, Pizza & Pies
Cereals & Spreads (honey, peanut butter, golden syrup)
Deserts, Chocolates & Snacks (crisps, cookies, nuts)
Sauces/ Stock Cubes (mint sauce, mayonnaise, vinegar, ketchup)
Drinks (fizzy drinks, hot drinks)

Declaration

It is important that the information in your application form is accurate. Please print and sign your name at the end of the form to confirm that the information you have given is true and complete and you are happy for Tesco Sensory Department & Sheffield Hallam University to hold your details. The information you provide will only be used for the application of Sensory Food Assessment Panellist.

Signature: …………………………………… Date: ………………….

Print Name: ………………………………….

Successful applicants will be invited to attend a screening session to establish their suitability as a potential panellist.

Please return to:

Sensory Panel Applications, Research and Knowledge Transfer Team, Sheffield Hallam University, Room 7301, Stoddart Building, City Campus, Sheffield, S1 1WB