Job Application Form

Position Applied for Date of Application Where did you hear about this job:

Are you legally allowed to work in the UK Yes No

For Which position you are applying Part Time Full Time contractor Guest Lecturer

This application form, rather than curriculum vitae (CV), is used to ensure that information is presented in a standardised format and that only the details we require are provided. This ensures that all applicants are treated fairly and equally. If there is not enough space provided on the form please continue on a separate sheet of paper.

Personal Details
Title: Surname: First Name(s): Address: Work telephone number: May we use your work number to contact you? Yes Mobile Telephone No: Evening Telephone No: E-mail: Nationality: Postcode: Date of Birth : NI Number: No

General Information
Do you require a work permit/ visa to work in the UK? Do you have a National Insurance Number? Have you previously worked or applied to work for us? If Yes, please give details and dates. Yes Yes Yes No No No

Amount of notice you are required to give your current employer: Please give details of any existing holiday commitments: When would you be available to Start:

Current Salary:

Eligibility For Employment In The Uk

Are you eligible for employment in the United Kingdom? Do you require Work Permit or visa to work in the United Kingdom Yes Yes No No

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If

Yes

Please explain in what capacity and visa type When your visa or leave to remain in the United Kingdom Expires When your Passport Expires : Please state what ORIGINAL documents you can provide in order to demonstrate this by ticking against the selected item(s):

One of: British passport European Economic Area identity card or passport Travel document or Passport showing an authorisation to

and: Document showing National Insurance number

reside and work in the UK Any Other Form of ID or a letter from UKBA authorising your stay and work in the United Kingdom

CURRENT EMPLOYER (or most recent employer if not currently employed)

Name and address of employer and nature of business Job Title Dates from / to (month / year) Reason for leaving

Main Duties, Responsibilities and Achievements:

Employment history
Starting with you most recent job, paid and/or unpaid, please list employment providing all of the details requested. If you are successful we will obtain references, which may cover a full three-year history, they could include time spent in education. In addition to information on ability and performance we will be seeking information on recent sickness Name of current/last employer: Address: Postcode: Employers telephone number: Job title: Date from: Reason for leaving: Salary: Leaving date or notice period:

Brief description of responsibilities:

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Previous employment: Address:

Employers name: Postcode: Post held: Date From:

Salary:

To:

Reason for leaving:

Previous employment: Address:

Employers name: Postcode: Post held: Date From:

Salary:

To:

Reason for leaving:

Previous employment: Address:

Employers name: Postcode: Post held: Date From:

Salary:

To:

Reason for leaving:

Please provide details of any gaps of employment history with dates

Please tell us how many days you have been absent from work due to sickness in the last 2 years: Total days: Physical Conditions Please state, with dates, any serious illnesses or operations you have had which may affect your ability to do this job.
Do you suffer from any recurring conditions? If yes, please give details: Do you regard yourself as in any way disabled * ? If yes, please give details: Yes Yes No No

Number of occasions:

If your answer is Yes, you should indicate whether there are any special requirements or reasonable adjustments, the College can help you overcome any problem, owing to your disability by either: In applying for this post (including attending interview, if selected): In carrying out the duties required of this post:

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Referees
Please give the details of two referees. One of these should be your line manager with your present and/or last employer.

Referees name: Post held: Address:

Your relationship with the referee: Telephone No: Mobile No: E-mail :

Postcode:

Referees name: Post held: Address:

Your relationship to with referee:

Telephone No: Mobile No: E-mail :

Postcode:

Data protection act 1998

The information given in this form will remain private and confidential and will be used for the purpose of recruitment and selection. The College has a need to hold personal data in relation to successful applicants for personnel administration purposes. Processing will take place in accordance with the provisions of the Data Protection Acts 1984 and 1998. In signing this form below, you are giving your consent for this information to be processed. Information relating to unsuccessful applicants will be destroyed as soon as possible, and no later than six months from the date of each appointment.

Declaration of Offences
Before completing this form, please read the following notes carefully.You must declare on this form all offences, convictions, cautions, or any court cases you may have pending. Convictions will not necessarily be a bar to employment with the LSA.
 Have you ever been cautioned or convicted of a criminal offence  Have you ever been disqualified from working with children or vulnerable adults  Do you have any unspent criminal convictions or cautions

If you do not have any, please write none Details of offence(s)

Place and date of Judgement(s)

Sentences (s)

Possession of a conviction or caution will not necessarily mean that you wont be appointed, each case is considered on its merits. All information given will be treated in the strictest confidence and will be used for this job application only. Name (please print): Signature: Date:

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