APPLICATION FORM

Please complete this form and return before the deadline.

By email:

By post: Charli Ward, Academy Director

Mind the Gap Studios

Silk Warehouse

Patent Street

Bradford BD9 4SA

Thank you for applying to work as an employee with Mind the Gap. The information you supply to us will be treated with the strictest confidence. If you have a disability or any other special need that means you are unable to complete this form please contact us by email or telephone 01274 487390 to make alternative arrangements.

Data Protection

By providing the information contained within this application form, you are consenting to its use for the purpose of processing your application, and assessing your performance in the future (should your application be successful). We reserve the right to validate all information entered on this form. If your application is unsuccessful your details will be retained for a maximum ofthree months.

DETAILS OF VACANCY

Reference

/ n/a

Position applied for

/ Associate Artist: MUSIC

How did you hear?

/ Newspaper Personal Introduction 
Agency Website
Email
Please give details if applicable (e.g. name of newspaper, website or email communication):
PERSONAL DETAILS

Surname

/ Mr/Mrs/Ms/Miss/Dr (delete as applicable)
Forenames
Address
Postcode
Work Telephone
Home Telephone
Mobile Telephone
Email Address
WORK PERMIT / NATIONAL INSURANCE NUMBER
Do you require a work permit to work in the United Kingdom? / Yes / No / (delete as applicable)
Please enter your National Insurance Number:
Please enter your Unique Tax Reference Number:

CURRENT/MOST RECENT EMPLOYMENT

Job Title

Employer’s Name
Employer’s Address
Start Date / End Date
Delete as applicable / Employee status or Freelance contract
Salary
Notice Required
Brief Outline of Duties
and Responsibilities
Reason for Leaving

PREVIOUS EMPLOYMENT

Job Title

Employer’s Name
Employer’s Address
Start Date / End Date
Delete as applicable / Employee status or Freelance contract
Salary
Brief Outline of Duties
and Responsibilities
Reason for Leaving

PREVIOUS EMPLOYMENT (continued)

Job Title

Employer’s Name
Employer’s Address
Start Date / End Date
Delete as applicable / Employee status or Freelance contract
Salary
Brief Outline of Duties
and Responsibilities
Reason for Leaving

Job Title

Employer’s Name
Employer’s Address
Start Date / End Date
Delete as applicable / Employee status or Freelance contract
Salary
Brief Outline of Duties
and Responsibilities
Reason for Leaving
EDUCATION AND TRAINING
Please give details of any training and courses that you have attended, and qualifications achieved, that you feel are relevant to your application. Please list most recent first.
Name of Education or Training Provider / Dates attended / Qualifications or Outputs Attained
SUPPORTING ADDITIONAL INFORMATION
Referring to the Person Specification and Job Description please tell us, in no more than 750 words, how your particular skills match up to the requirements of this role.
Continue on this page if necessary:

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APPLICATION FORM

ACCESS NEEDS
Do you have a disability or any medical condition which might affect how you carry out the responsibilities of this contract or which has been a factor in previous employment?NB: Mind the Gap will not discriminate unfairly, and is committed to making all reasonable adjustments in order to meet the access needs of employees. / Yes /

No

/ (delete as applicable)
If Yes please give brief details here. If you are invited for interview we will ask about access requirements in more detail.
CRIMINAL RECORD
Have you been convicted of any criminal offences which are not yet spent under the Rehabilitation Of Offenders Act 1974? / Yes / No / (delete as applicable)
If Yes please give further information.
Are you facing any criminal prosecutions? / Yes / No / (delete as applicable)
If Yes please give further information.
REFERENCES
Please give the names and addresses of two referees, one of whom should be your present or most recent employer. Your referees will not be contacted prior to interview or without your permission.
Name / Name
Position / Position
Company / Company
Address / Address
Telephone / Telephone
Email: / Email:
DECLARATION
I declare that the information contained in this form is true and complete. I understand that if it is discovered that any statements are false or misleading I will be liable to have my application disqualified or subsequently will be liable to be asked to leave the employment ofMind the Gap.
Signed / Date
Please note email is not a secure form of communication and Mind the Gap cannot be held liable for any information that is lost or received by an unintended recipient.
Personnel Use only: / Date application received:

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