NASUWT

An Equal Opportunities Employer

Please read the enclosed papers before completing this form.

APPLICATION FORM

Ref. No.

For the position of

1. Personal Information

Name / Tel No.(Home)
Preferred title Mrs/Ms/Miss/Mr / (Work)
Address / (Mobile)
National Insurance Number
Postcode / Current Salary
E-mail address (if applicable)
Do you hold a fullYES NO
driving licence? 
(please tick box if this is a requirement for the job)
I am not and have never been a member
of the BNP or any other racist organisation  / Do you have any convictions, cautions, reprimands or final warnings that are not protected as defined by the rehabilitation of offenders Act 1974 exceptions order 1975 (as amended 2013).
YES NO 
(NB you do not need to disclose convictions deemed spent under the Rehabilitation of Offenders Act 1974 exceptions order 1975 amended 2013. Please refer to Page 2 of “Completing the Application Form – Guidance for Applicants”).

2. Qualifications and Education

Qualification, including level of award / School/College/University / Dates

3. Employment History (continue on separate sheet if necessary)

Please note that under Section 8 of the Asylum and Immigration Act 1996 we must obtain evidence that the successful applicant is entitled to be employed in the United Kingdom.

Present and previous employment (most recent first) / Position held and brief description of duties / From / To / Reason for leaving

4. Supporting Information

Describe your experience, skills, knowledge and commitment which are particularly applicable to the post. Please read the section of ‘Completing the Application Form – Guidance for Applicants’ which refers to this page.

5. Referees

Name and details of two referees, the first of whom must be your current or most recent employer.

They will only be contacted after an offer of employment has been made.

1
Name of Referee
Status/Position Held
Relationship to you
Employer Name
Employer Address
Postcode
Tel No.
E-mail address / 2
Name of Referee
Status/Position Held
Relationship to you
Contact Address
Postcode
Tel No.
E-mail address

Please return completed form to:

Personnel and Development

NASUWT

Hillscourt Education Centre,

Rose Hill, Rednal,

Birmingham B45 8RS

EQUAL OPPORTUNITIES MONITORING

NASUWT is committed to ensuring equality of opportunity for all, irrespective of gender, ethnic origin, disability, sexuality, religion or age. The following information will be used by NASUWT for recruitment monitoring purposes. Information will be treated in confidence and in accordance with the provisions of the Data Protection Act 1998.

This sheet will be detached from the application form and will not be seen by those involved in the selection process.

Age

What is your date of birth?___/ ____/ ____ (dd/mm/yyyy)

Disability

Do you have a disability/impairment?YES NO

If so, which of the following categories best describes your disability/impairment? (Please tick as many as apply)

Chronic medical conditionsHearing impairment/deafness

(e.g. epilepsy, diabetes, ME, asthma)

Mental health difficultiesMobility impairment

(e.g. depression, schizophrenia, phobias)

Learning difficultyVisual impairment

Other impairment (please specify) 

Ethnic Origin

Which of the following best describes your ethnic background? (Please tick one box only)

Asian or Asian BritishBlack or Black BritishOther Ethnic Group

BangladeshiAfricanChinese

IndianCaribbeanOther ethnic group

Pakistani Other Black backgroundPlease specify

Other Asian background Please specify

Please specify

Mixed HeritageWhite or White British

White & AsianEnglish

White & Black African Irish

White & Black CaribbeanScottish

Other mixed backgroundWelsh

Please specify Other white background

Please specify

Gender

Are you:FemaleMaleTransgender(please tick one box only)

Religion or Belief

Which of the following best describes your religion or belief? (please tick one box only)

Baha’iHinduMuslimZoroastrian

BuddhistJainRastafarianOther religion or belief

(please specify)

ChristianJewishSikhNone

Sexual Orientation

Do you define yourself as

BisexualGayHeterosexualLesbian 

(please tick one box only)

Post applied for

Where did you see it advertised?

Signed Date:

Name (please print)

Application Ref: ……..112/12/18