Please Give Details of Post-Primary Degrees, Diplomas Or Certificates

For the Post Of:

Closing Date:

This application form must be completed in all parts in BLACK INK or TYPESCRIPT and returned to y the date specified. Failure to do so may result in the application being rejected. It is the responsibility of the applicant to include all information, which demonstrates how they meet the criteria of the post (including qualifications or equivalent).

1 PERSONAL DETAILS (PLEASE COMPLETE IN BLOCK CAPITALS)
SURNAME:
AND ANY PREVIOUS SURNAME: / First Names:
Title: / Date of Birth:
Address:
Previous Address (within the last 5 years): / Telephone Numbers:
Home:
Work:
Mobile:
Private e-mail:
National Insurance No:
2 SECONDARY / FURTHER EDUCATION
Awarding
Body / Subject / Level
Eg GCSE, ‘A’, Vocational / Grade / Date
3 UNIVERSITY / 3rd LEVEL EDUCATION
Name Of University/College / Dates / Full or
Part Time / Degree/s Awarded / If Honours, State Class And Division
ADDITIONAL QUALIFICATIONS

Please Give Details Of Post-Primary Degrees, Diplomas Or Certificates

Date / Name Of Awarding Or Examining Body / Qualification/Award / Grade
From / To

MEMBERSHIP OF PROFESSIONAL BODIES

Name of Body:
Date Membership conferred:
Current Membership Status:
PRESENT OR MOST RECENT POST
Name & Address of Employer:
Date Appointed: Temporary / Permanent
(Delete As Appropriate)
Job Title: / Current or Most Recent Salary:
Current Notice Period:
Please give a brief description of duties undertaken in the post:
PREVIOUS EMPLOYMENT – ( Most Recent First)
Name & Address Of Employer / Post Held and Brief Outline of Duties Attached to Post / Salary / Date
From / To
PREVIOUS EMPLOYMENT – ( Most Recent First)
Name & Address Of Employer / Post Held and Brief Outline of Duties Attached to Post / Salary / Date
From / To
PREVIOUS EMPLOYMENT – ( Most Recent First)
Name & Address Of Employer / Post Held and Brief Outline of Duties Attached to Post / Salary / Date
From / To
Please account for any break in your employment history:
MEDICAL HISTORY
Please give details and approximate dates of all periods of sickness during the past 2 years
Reason for Sickness Length of Absence from Work
INFORMATION IN SUPPORT OF YOUR APPLICATION
Please detail and demonstrate how you meet each and every aspect of the criteria as detailed in the personnel specification.
Essential Criteria

Desirable Criteria

Further information in support of your application

REFERENCES

Please give the names and addresses of three referees, at least two of whom must be able to comment on your professional competence. References may not be sought from any member of East Belfast Enterprise who is involved in the selection procedure.

Name / Position / Address / Telephone No/Email

MAY WE ASK YOUR PRESENT EMPLOYER FOR A REFERENCE IF REQUIRED?YES/NO

CRIMINAL OFFENCES
Have you been convicted of a criminal offence, cautioned or bound over or is a charge pending? If ‘yes’, give details including the nature of offence and penalty (if any)
YES / NO ………………………………………………………………………………..
NOTE:This post is exempt from the provisions of the rehabilitation of offenders order (Northern Ireland) 1978 by virtue of the rehabilitation of offenders (exceptions) order (Northern Ireland 1979) and the rehabilitation of offenders (exceptions) (amendment) order (Northern Ireland) 1987. Applicants must therefore disclose information about convictions which might otherwise be regarded as spent under the provisions of the order. Failure to disclose such convictions could, in the event of employment, result in disciplinary action up to and including dismissal.
DECLARATION OF APPLICANT
I declare that all the foregoing statements are true and complete to the best of my knowledge and belief. I understand that knowingly giving false information or suppressing any material fact will lead to disqualification or, if appointed to dismissal.
In the event of my application being successful, I consent to a check being made with police to determine if there is any record of convictions, cautions or bind-overs against me.
Signature: ………………………………………………….. Date: ……………………
CANVASSING WILL DISQUALIFY

Please ensure that you have completed all sections of this form and return it by the closing date to: Kenny Rodgers, Suite 402, City East Business Centre, 68-72 Newtownards Road, Belfast BT4 1GW or preferably by email to