APPLICATION FORM

Please type or write in black ink. Please do not use staples.

Post applied for:Youth Drama Leader

Personal Details

Surname: / Other Names:
Address:
Home Number: / Work Number:
Mobile Number: / E-mail Address
Nationality / National Insurance Number
Are you allowed to work in the UK? / YES / NO / Do you require a work permit? / YES / NO
Most Recent Employment (Paid or Unpaid)
Name of Organisation: / Job Title:
Date of appointment: / Current or Final Salary/wage (if any):
Period of notice required / Leaving date if now not working:
Give a brief outline of your responsibilities:
Reason for leaving (or for seeking other employment):
What is your current notice period and are there any other factors that will affect your potential start date.
(Please note this will not unduly affect the short-listing process)
Previous Employment (Paid or Unpaid)

Please do not use more than 2 pages for this section

Name of Organisation:
Job Title:
Date of appointment: / Leaving date:
Brief description of duties
Name of Organisation:
Job Title:
Date of appointment: / Leaving date:
Brief description of duties
Name of Organisation:
Job Title:
Date of appointment: / Leaving date:
Brief description of duties
Name of Organisation:
Job Title:
Date of appointment: / Leaving date:
Brief description of duties
Name of Organisation:
Job Title:
Date of appointment: / Leaving date:
Brief description of duties

1

Education Training and Professional Qualifications

Please do not use more than 1 page for this section
School, College etc. / Qualification Obtained / Date Obtained

1

Using the job description and person specifications as a guide, please outline why you are interested in the post and how your skills and experience meet the criteria for this role.
(You may continue on ONE additional page if required)

1

Referees

Please give the name and address of two referees. Where possible referees should have known you at work/school/college and one referee should be your present or most recent employer (if applicable)

Name / Name
Occupation / Occupation
Address / Address
Contact number / Contact number
E-Mail / E-Mail

May we request referenceMay we request a reference

At any time At any time

Only after offer of employment Only after offer of employment

Declaration

In order to comply with the Immigration Act 1996 we are required to see proof of your right to work in the UK. This will be requested once an offer of employment has been made. However, if you require a work permit in order to work in the UK please indicate by ticking this box:

Please give details of any criminal convictions you have had, excluding any considered “spent” under The Rehabilitation of Offenders Act 1974 (minor motoring offences should be disregarded):

To the best of my knowledge the information on the application form and equal opportunities monitoring form is correct.

If emailing this document please type your initials and date this section.

Signature / Date

1

Equal Opportunities Monitoring Form

In order to monitor the effectiveness of our equal opportunities recruitment policy it is important to collect information that might identify possible direct and indirect barriers to employment. In line with our commitment, any information provided is entirely confidential, and is not part of any selection procedure.

Please Note: You may choose not to provide information on specific questions

PLEASE DOUBLE CLICK ON THE BOX TO MARK IT AS CHECKED

Post applied for:Youth Drama Leader

Please specifically state how you found out about the job, clearly stating the press, website, mailing list or any other sources:

Personal Details

Name:

Please indicate which age range you fall into:Under 1818 – 25

26 – 3536 – 45

46 – 55Over 55

Gender: Male FemaleOther

Sexuality: Heterosexual Homosexual Bisexual Transsexual

Other (Please State)

Do you consider yourself to have a disability?YesNo

Are you a Hackney resident? YesNo

Cultural Diversity

Please tick the ethnic category that best represents you. As you make your decision, please think about what ethnic group means to you, that is, how you see yourself. Your ethnic category is a mixture of culture, religion, skin colour, language and the origins of yourself and your family. It is not the same as nationality.

White

British

Irish

Any other white background, please state______

Asian or Asian British

Asian Bangladeshi

Asian Indian

Asian Pakistani

Any other Asian background, please state______

Black or Black British

Black African

Black Caribbean

Any other Black background, please state ______

Chinese or other ethnic group

Chinese

Any other, please state______

Dual Heritage

Dual Asian & White

Dual Black African & White

Dual Black Caribbean & White

Dual Chinese & White

Any other background, please state______

Any other background, please state______

Do you identify as belonging to a faith group? If so please state which: