Candidate identification number (for office use only) …………………….

/ APPLICATION FOR EMPLOYMENT
Application for post of
PERSONAL DETAILS
First name(s)
Surname (Family name) / Mrs / Miss / Ms / Mr
Home Address
Postcode
Please state where you saw the advert for this post
Contact Details / Please provide the following contact numbers on which we may contact you with discretion.
Home / Mobile
Work / Email
DATA PROTECTION
We will keep the data obtained from this application form and associated documents e.g. references, in secure conditions in accordance with data protection requirements. The information you supply will be kept as part of your employment record which may also be used and kept by our HR Advisors. If you are unsuccessful we will destroy your records within 6 months of your application. We do continue to keep anonymous information for monitoring purposes principally to comply with anti-discrimination legislation.
DECLARATION BY APPLICANT
The information I have supplied in this application form and accompanying sheets is complete and correct. I understand that if I provide false or misleading information I may be disqualified from the selection process or be dismissed if I have been appointed. I agree that the information I have supplied can be stored on computer or held manually as detailed in the section above.
Full Name (please print)
Signature / Date

1.  GENERAL EDUCATION / QUALIFICATIONS (Please give details of relevant education)

Dates: / Institution: / Qualifications obtained:

2.  TRAINING COURSES (Please give details of relevant work related training courses)

Course date(s): / Course title and areas covered: / Course provider:

3.  MEMBERSHIP OF PROFESSIONAL BODIES

Organisation: / Membership Status: / Membership Number:

4.  EMPLOYMENT HISTORY

a)  Current (or last) Position:

Employer:
Dates employed (month and year):
Grade/Salary:
Post Occupied and Main Duties
Reason for leaving

b) PERIOD OF NOTICE

Please state the period of notice required to terminate present employment:

c) PREVIOUS POSITION/S (Continue on a separate sheet if needed)

Date(s): / Employer: / Post Occupied and Main Duties: / Grade/Salary:

5.  NAMES AND ADDRESSES OF TWO REFEREES (Please note that personal or academic referees will only be accepted if there is no previous employer)

Reference 1
Name
Job Title
Address
Postcode
Telephone Number
Email
Relationship to the applicant
Can we contact this referee without further reference to you? / Yes / No
Reference 2
Name
Job Title
Address
Postcode
Telephone Number
Email
Relationship to the applicant
Can we contact this referee without further reference to you? / Yes / No

6.  STATEMENT IN SUPPORT OF APPLICATION

Please read the accompanying Job Description and Person Specification carefully and tell us how your work and other experience, education and training match the requirements of the job, giving examples where appropriate.

Thank you for taking the time to complete this application form.

EQUAL OPPORTUNITIES MONITORING FORM

Cycling UK is committed to fair and equitable treatment for all. The information on this form will only be used to monitor recruitment of staff and volunteers and will not be used in the selection process. We hope you will want to complete this form. However, if you choose not to, your application will not be adversely affected. The information collected will be collated and shared, anonymously and in aggregate only.
Please place an ‘X’ in the appropriate boxes.
1. Which position have you applied for:
2. Gender:
Male / Female / Transgender
3. Age:
16 or under / 35 to 44 years / 65 years +
16 to 24 years / 45 to 54 years
25 to 34 years / 55 to 64 years
4. Do you consider yourself to have a disability?
The Equality Act defines disability as ‘a physical or mental impairment which has a substantial and long term effect on a person’s ability to carry out normal day to day activities’.
Yes / No / Prefer not say
Please state if you have any access needs:
5. Ethnic Origin:
White English / Welsh / Scottish / Northern Ireland / British / Mixed Other / Black or Black British Other
White Irish / Asian or Asian British Indian / Chinese
White Eastern European / Asian or Asian British Pakistani / Arab
White Other / Asian or Asian British Kashmiri / Other
Mixed White / Black Caribbean / Asian or Asian British Other / Don’t Know
Mixed White / Black African / Black or Black British Caribbean / Gypsy or Traveller
Mixed White / Black Asian / Black or Black British African / Prefer not to say
6. Religion:
No religion / Hindu / Sikh
Christian / Jewish / Other
Buddhist / Muslim / Prefer not to say
7. Which of the following best describes how you think of yourself?
Heterosexual / Straight / Gay / Lesbian
Bisexual / Other / Prefer not to say
8. Equality Monitoring
I do not wish to participate in this monitoring exercise

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