CONFIDENTIAL

Application Form for post ofCURATOR (Maternity contract)

Please type or write in black ink as this form may be photocopied. Please complete your application form as fully and concisely as possible based on the information we have provided, with reference to the person specification in particular.

1Personal details (BLOCK CAPITALS)

Full name

Address

Postcode

Tel day:Tel evening:

Mobile:Email:

2References

Please give the names and addresses of two referees (who are not related to you), one of which must be your current or most recent employer.

1. Name:
Occupation:
Address:
Postcode:
Tel no:
Email: / 2. Name:
Occupation:
Address:
Postcode:
Tel no:
Email:
In what capacity do you know your second referee?

If shortlisted, may we contact these referees without further authority from you?

1. Yes/No2. Yes/No

3Present or most recentemployment

Employer’s name and address / Dates
from / to / Position held and summary of duties / Reason for leaving
Salary / Notice required

4Previous employment

Please start with the most recent job, before the one detailed above.

Continue on a separate sheet if necessary.

Employer’s name and address / Dates
from / to / Position held and summary of duties / Reason for leaving

5Education, professional qualifications, other relevant experience

Education

Schools, colleges, universities / Dates / Qualifications gained
(including subjects and grades)

Professional qualifications

Professional body / Qualification / Date obtained

Relevant training

Please give details of any other qualifications, training or experience which you consider to be relevant to your application, including those gained outside the workplace.

Work Permit

Are you eligible to work in the UK?

Criminal Convictions

Please list any criminal convictions other than “spent” convictions. If none, state “none”

The information provided will be confidential and will be considered only in relation to this application.

6Supporting statement

Please explain why you are applying for this post and how your skills, experience and achievements make you suitable for this job. Please refer to the information enclosed with this form and, in particular, the criteria in the ‘person specification’ on the job description. (No more than 2 sides of A4)

7Availability and interview arrangements

Please note, we intend to hold interviews on Friday 17 November. If thisdateisinconvenient, please advise us in this section.

Please sign and date this form

I declare that the information I have given in this application is, to the best of my knowledge and belief, true and correct. I understand that any job offer made on the basis of untrue or misleading information may be withdrawn or my employment terminated.

Signature ______Date ______

Please return the completed form by email to or by post in an envelope marked ‘CONFIDENTIAL’ to:

Isabel Jones

Office and HR Manager

Spike Island

133 Cumberland Road

Bristol BS1 6UX

Equal Opportunities Policy

Statement

SpikeIsland is committed to a policy of equal opportunity in its recruitment of employees, in its employment practice and in all aspects of its role as a company limited by guarantee with charitable status.

Employees are accepted by the application of objective criteria and personal merit. No candidate will be treated less favourably than another on grounds of race, nationality, ethnic origin, disability, religion, social class, sex, sexual orientation or marital status.

SpikeIsland continually strives to ensure that the building that the organisation occupies is fully accessible premises.

All information given will be treated with the strictest confidence and will be held for statistical purposes only, it does not form part of your application. The interviewing panel will not see this form. Although you are not under any obligation to complete this questionnaire the information you provide will help us to monitor our equal opportunities policy.

Equal Opportunities Monitoring Form

Please tick the appropriate box:

Gender Male Female

Age Less than 20 years 50 – 64 years

20 – 34 years 65 years and over

35 – 49 years

Cultural Diversity

It would be helpful for us to have on record information regarding your ethnicity. We are offering two methods for you to register these details. Please choose one you feel is most appropriate.

Method 1. Please describe your ethnic origin.

Method 2.

Please tick the ethnic category that best represents you. Choose one section from A to E, then tick the appropriate box to indicate your cultural background. (The categories are those recommended by the Council for Racial Equality)

A. White

British

Irish

Any other White background, please state ______

B. Dual Heritage

Asian and White

Black African and White

Black Caribbean and White

Chinese and White

Any other background from more than one

ethnic group, please state ______

C. Asian or Asian British

Indian

Pakistani

Bangladeshi

Any other Asian background, please state

______

D. Black or Black British

Caribbean

African

Any other Black background, please state ______

E. Chinese or Chinese British

Chinese

Any other, please state ______

Disability

Do you consider yourself to have a disability or health condition?

YES NO PREFER NOT TO SAY

What is the effect or impact of your disability or health condition on your ability to give your best at work? Please write in here:

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

If you are a job applicant, can you please inform us of any access requirements you may have that will assist you in your interview? (e.g. large print, BSL interpreter etc)

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

Sexual orientation

What is your sexual orientation?

Heterosexual/Straight

Gay woman/lesbian

Gay man

Bisexual

Prefer not to say

If other, please write in:……………………………………………………………………………………………

If applying for an advertised vacancy, where did you hear about this opportunity?

Thank You for your Cooperation

The information in this form will be kept in the Spike Island office for internal use only.

Please inform us if any of the details change.

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