Please Complete This Form Fully and Return To

application form

Please complete this form fully and return to

Please note: We do not accept applications which are CV/Covering letter only.

This information will be treated as confidential and will not be disclosed without your permission. We are required under the Data Protection Act 1999 to inform you that some data you have supplied will be held on computer or paper-based files.

If you have difficulty completing this application form, or you have a disability which prevents you from completing this form, please contact the Human Resources Department on 0207 380 6600

Position Applied ForClosing Date:

Personal information

Surname / Forename / Title (Dr, Mr, Miss, Mrs, Ms etc)
National insurance no / Date of birth / Nationality
Address for correspondence / Telephone number
Postcode
Mobile telephone number
Email address / Work telephone number

Interview arrangements

Dates NOT available for interview
What is your period of notice and when could you take up appointment if your application is successful at?

Immigration information

NON-EU citizens Only: Will you require a work permit to take up employment with NUS? / Yes / No
If ‘Yes’ please provide your home office reference number. This is to verify compliance with the Immigration, Asylum and Nationality Act 2006.
Are there any restrictions on your continued residence or employment in the UK? / Yes / No
If ‘Yes’ please give details.

Employment history (Please include both paid and unpaid work)

Present or most recent employer Name:
Address / Position held
Postcode / Dates of employment
Start Date / End Date
Reason for leaving
Description of duties /responsibilities / Current Annual Salary (exc. benefits)
Additional Benefits
Previous employment
Employer Name:
Address / Position held
Postcode / Dates of employment
Start Date / End Date:
Reason for leaving
Description of duties /responsibilities / Current Annual Salary (exc. benefits)
Additional Benefits
Employer Name:
Address / Position held
Postcode / Dates of employment
Start Date / End Date
Reason for leaving
Description of duties /responsibilities / Current Annual Salary (exc. benefits)
Additional Benefits
Employer Name:
Address / Position held
Postcode / Dates of employment
Start Date / End Date:
Reason for leaving
Description of duties /responsibilities / Current Annual Salary (exc. benefits)
Additional Benefits
Employer Name:
Address / Position held
Postcode / Dates of employment
Start Date / End Date:
Reason for leaving
Description of duties /responsibilities / Current Annual Salary (exc. benefits)
Additional Benefits

Education, qualification and training

Education establishment / Qualification received / Date
Personal Development(which is relevant to this post)
Details / Date

Supporting statement:

Please show how your experience, skills and knowledge meet the criteria as set out in the Person Specification, providing demonstrable examples where possible. Please limit your response to 2 pages only.

Rehabilitation of offenders act 1974

Have you ever been convicted of a criminal offence? / Yes / No
If ‘Yes’ please provide details
Have you had a CRB Check in the last 6 months? / Yes / No

Health Record

Do you know any health issues that would prevent you from carrying out the duties required by this position?

Yes

If ‘Yes’ please provide details

How many days’ sick have you had in the last 12 months?

Other

Are you related to or do you have a personal relationship with any NUS employee, Elected Officer, Trustee or Board Member

Yes

If ‘Yes’ please provide details

How did you hear about this position? (Name of publication/website)

Referees

All appointments are subject to receipt of satisfactory references. Please give details of two people who we can approach for references. We will not approach your referees without your permission. Both referees should be from previous employment; one should be your present or most recent line manager. NUS does not accept referees who are friends or work colleagues in an equivalent or junior role to the most senior position you have held at that organisation

Name / Name
Address
Postcode / Address
Postcode
Can we approach this referee immediately? / Yes No / Can we approach this referee immediately? / Yes No
Position held / Position held
Telephone no / Telephone no
Fax no / Fax no
Email / Email

Declaration

The details on this application are correct to my knowledge and belief. I understand that withholding relevant information or giving false information may result in my application being rejected or that I may be dismissed if I have already been appointed.
Signed:Date:

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Equalities and diversity monitoring form

In order to ensure the continued development and effectiveness of the equalities and diversities policy all applicants are asked to complete this form. The information on the form will be used solely in pursuance of NUS’s Equalities and Diversities and will be treated as confidential

Personal data will be treated in strict confidence and will not be seen by those directly involved in the HR process or effect your marks or results in any way. The information on this form will be used for monitoring purposes only.

Personal Details:

Title: / Mr / Mrs / Miss / Ms / Dr / Other
Surname:
First Name:
Position Applied for:
Age: / 16-24 25-34 35-44 45-54 55+
Gender: / Male Female Prefer not to select
Working Pattern: / Part timeFull time

Ethnic Origin: Please tick against one of the following

Asian or Asian British

Indian
Pakistani
Bangladeshi
Any other Asian background /

Mixed

White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background

Black or Black British

Caribbean
African
Any other Black background /

White

British
Irish
Any other White background

Chinese or other ethnic group

Chinese
Any other /

Prefer not to select

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Disability: Please tick against one of the following

Do you consider yourself to have a disability within the meaning of the Disability Discrimination Act 1995?
The Disability Discrimination Act 1995 defines a disabled person as someone who has a physical or mental impairment, which has substantial and adverse long-term effect on his or her ability to carry out day-to-day activities. Conditions covered may include, for example severe depression, dyslexia, diabetes, epilepsy and arthritis.
Having read this do you consider yourself to be covered by the definition?
YesNoPrefer not to select
If you answered yes, can you please indicate the day-to-day activities affected by your disability. (Please indicate as many as applicable)
Eyesight Mobility
Hearing Speech Manual Dexterity
Physical Coordination
Ability to learn or understand, or memory
Ability to lift, carry or move everyday objects
If you wish, please state your disability here:
Please give details of any special arrangements you may require:

Religion or Belief: Please tick against one of the following

No religion / Atheist
Bahai / Jewish
Buddhist / Muslim
Christian / Sikh
Hindu / Other
Jain / Prefer not to select

Sexual orientation: Please tick against one of the following

Bisexual / Gay Man
Gay Woman / Lesbian / Heterosexual / Straight
Prefer not to select

Information given on this form may be used to update databases used to identify diversity issues and the need for positive action, this data will be used for monitoring purposes only. Only a small number of authorised people have access to diversity data whatever held.

Thank you for completing this form

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