Application Form Application for the role of: State here which role: Please complete this form as fully as possible 1. Personal Details Title: Surname: Forenames: Home Address: Postcode: Present/Correspondence Address (if different):
Postcode: Home telephone: Mobile telephone:
E-mail address:
2. (a) Present/Last Employer/Contracting Organisation Present/Last employer: Name and address:
Brief description of role:
Date started: Date left: Notice period (if appropriate): Salary/Fee: Length of contract: Reason for leaving/wishing to leave (if appropriate):
(b) Previous employment/contractors (most recent first) Name of employer
Job title/brief
Date Started
Date Left
Reasons for Leaving
3. Education/Training Schools (Secondary)
Date Started
Date Left
Subject(s)
Grade
Further Education College/University
Date Started
Date Left
Subject(s)
Grade
Continued
2
4. Important Information Please detail here how your skills, experience and interests match the essential criteria for the role (continue on a second sheet if necessary)
3
5. Rehabilitation of Offenders Act 1974 Please declare any criminal convictions against you, excluding any convictions which are “spent� under the above Act. (If appropriate please state NONE TO DECLARE)
6. References Please give the details of TWO persons from whom references may be requested in respect of your application. (Please note that references may be taken for applications short-listed for interview)
Reference 1 Name: Job Title: Address: Email: Reference 2 Name: Job Title: Address: Email:
7. Declaration The data on this application form will be used for the purpose of personnel administration and legitimate issues relating to employment. Nottingham Lakeside Arts will observe the principles of the Data Protection Act 1998 at all times. I confirm that the details given by me in this application are accurate. I understand that any false statement or failure to disclose information, where required to do so will if engaged, render me liable to disciplinary action which may include dismissal. Signed:
Date:
4