Application form

Vacancy:

Please say where you saw this vacancy advertised:

Section 1: Contact details

Name:
Address:
Telephone:
Mobile:
e-mail:

Section 2: Education

Please give details of your educational attainments, including: subject/discipline; relevant qualifications obtained and/or examinations passed; membership of professional bodies; courses/training undertaken.

September 2016

Section 3: Employment

Name and address of employer / Dates / Job title and brief summary of duties / Reason for leaving
Are you able to provide proof of your entitlement to work in the UK? Yes/No
In accordance with Section 8 of the Asylum and Immigration Act 1996, an offer of employment will only be confirmed upon receipt of original documentation e.g. N.I. Number, P45, Passport.

September 2016

Section 4: Supporting statement

Please write a statement explaining how you are a good candidate for this post. Please read the job description and person specification carefully, and clearly indicate the skills, knowledge and experience you have to fulfil the role.
(Please continue on a separate sheet if necessary, to a maximum of two sides).

September 2016

Section 5: Referees

Please include names and addresses of two referees. Both referees should be previous employers and one of them should be your current or most recent employer. We reserve the right to contact other previous employers if necessary.We will not contact your present employer unless and until we have decided to offer you the job.

First referee (contact at your present/most recent employer)

Name and position
Relationship to candidate
Organisation name
Organisation address
Telephone
E-mail

Second referee (a previous employer)

Name and position
Relationship to candidate
Organisation name
Organisation address
Telephone
E-mail

September 2016

Declaration

Consent notice and fair processing of information for application forms

Notice given in accordance with the Data Protection Act 1998:

By signing and returning this application form, you consent to the Academy of Medical Sciences:

  • Obtaining, keeping, using and producing information relating to your application for a job with the organisation for one year in order to consider whether to offer you any position, the terms on which to make such an offer, to answer any reasonable queries about the application and to monitor the recruitment process.
  • Keeping for one year and processing information including details about disability and ethnic origin in order to enable the Academy of Medical Sciences to monitor equal opportunities and establish whether the Academy of Medical Sciences is attracting applicants representative of the population mix in the local community; also to enable the Academy of Medical Sciences to consider whether you require any reasonable adjustments to be made during the application process or, if offered a job, to assist in the performance of your duties.

Under the Act, the person or organisation that decides how information about individuals is used is known as the data controller. In our case, the Academy of Medical Sciences is the data controller. The Executive Director is responsible for ensuring that we comply with our obligations under the Act.

I certify that the details I have given are correct.
All applications need to be signed to be valid
Signed / Date

September 2016

Equal opportunities

Please note: All information you wish to provide on this page is confidential, used only for statistical purposes and is not seen by interviewers.

The Academy of Medical Sciences accepts its responsibilities to reflect the communities in which it works. We are therefore committed to a policy of Equal Opportunities and applications are welcome regardless of gender, marital status, sexual orientation, age, disability, ethnic origin, or religious belief.

The Academy of Medical Sciences encourages applications from disabled people and disabled applicants may telephone our office to discuss access arrangements and the level of physical ability necessary for this job before applying.

Do you regard yourself as disabled:Yes  No
Are you:Male Femals
Gender identification if different from above:
Would you classify yourself as (please tick one box):
White
British
Irish
Other White Background
Black or Black British
African 
Caribbean 
Other Black Background
Asian/Asian British
Indian 
Pakistani 
Bangladeshi
Other Asian Background 
Mixed
White and Black African
White and Black African 
White and Asian
Other Mixed Background 
Chinese 
Vietnamese
Other South East Asian
Prefer not to answer
Other Ethnic Background (please state):

September 2016