Internship applied for:
Completed form to be returned to:
Careers and Employability, York St John University, Lord Mayor’s Walk, York YO31 7EX or
Emailed to
Surname: Other Names:
Title:Mr/Mrs/Ms/Miss/Other (please specify)
Address:
Post code:
Home Tel No: Mobile Tel No: Ext:
E-mail address: National Insurance No:
Do you hold a visa which gives you the right to work in the UK
What course are you studying?
What year of study are you in?
Please give details of two referees who have knowledge of your work and character and can provide information about your work experience and skills. One of these should be your present or most recent employer and the other your academic tutor.
Name: Name:
Address: Address:
Position: Position:
Tel No: Tel No:
Relationship to you: Relationship to you:
Do we have your permission to take up these references prior to interview? Yes No
I consent to all data collected on this form and further data I have submitted in support of my application, including, where relevant, data relating to my physical or mental health or condition, my ethnicity and any criminal convictions, being processed by York St John University for the purposes of evaluating my qualifications and suitability for employment to reach an acceptance or rejection decision, to meet government statistical or legal requirement and to populate a personnel record.
I certify that the information I have given on this form and supporting documents is correct to the best of my knowledge and that I have not omitted any facts which may have a bearing on my application. I understand that if any of the information provided by me is found to be false, any contract of employment may be terminated without notice. If you are submitting the form electronically, please enter your name or your electronic signature below. In doing so, you confirm that information is correct, as if the document had been signed and dated by hand.
Signed: Date: