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LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Application Form This form can be supplied in larger print on request. Post applied for: __________________________________________ Personal details Title: First Name: Last name: Address:

When would you be able to start employment?

Telephone: home Telephone: work Mobile: Email: May we contact you at work? No/Yes (please delete) National Insurance number:

Are you required to have a permit to work in the UK? No/Yes (please delete)

Do you hold a full valid current driving licence? No/Yes (please delete)

If yes, do you have a valid permit? Yes/ No If yes, when does it expire?

Employment history Present or most recent employment Dates From/To

Name and address of Employer

Post held

Please describe your main duties and responsibilities LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355

Salary


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Previous employment (begin with the most recent) Dates From/ To

Employer

Post Held and brief description of main responsibilities

Reason for Leaving

Education, training and qualifications Secondary and Further Education (CSE, GCSE, O and A levels, RSA, BTEC, Degree, etc.) School/College/University

Examinations/Qualifications and Levels obtained

Professional or other training courses attended (include relevant in-house training courses)

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Training provider

Title of course/qualification

Dates

Duration

Voluntary work, community work, etc. Please describe in terms of the skills, knowledge and experience you have gained.

Under the following headings, describe how your experience, skills and knowledge meet the requirements of these essential factors on the person specification. Skills and Experience (essential)

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Knowledge (essential)

Equal Opportunities (essential)

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

General (essential)

Skills and Experience (desirable)

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Knowledge (desirable)

Suitability for the post Please describe why you feel that you are suitable for the post and why you are interested in this position. Continue on additional sheets, if necessary.

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Do you consider yourself to be disabled?

Yes

No

So that the Excellence Centre can support people with a disability, we need to know if you have a disability or if there are any arrangements or adjustments we could make for you. If you are a disabled person and meet the essential requirements of the job, as shown on the enclosed ‘person spec’ you will be guaranteed an interview. At your interview, the interviewers will concentrate on your ability to do a particular job, not your disability. My disability is (brief details)

The interview arrangements the Excellence Centre would need to make are:

Adjustments the Excellence Centre would need to consider to enable me to carry out the job are:

References Please give the names, addresses & telephone numbers of TWO referees. The first should be your present or most recent employer. (School or College Principal if you have not worked before) Please make sure that your referees are informed that we will contact them about your application. Name: Position: Organisation: Address:

Name: Position: Organisation: Address:

Tel. No. May we contact this referee before interview? No/Yes

Tel. No. May we contact this referee before interview? No/Yes

If you are related to an Excellence Centre employee or a member of the Board of Trustees, please give details on a separate sheet. Note: Canvassing or failing to disclose a relationship may disqualify you.

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355


LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish

Declaration I understand that an appointment, if offered, will be subject to the information on this form being correct. I also understand that appointment will be subject to satisfactory references and obtaining occupational health clearance. I hereby certify that the information I have given in this application is true to the best of my knowledge and belief. Signed:

Date:

If you are submitting this application via e-mail, you will be required to sign a copy during the interview.

Please return to: Chief Executive Officer, LGBT Excellence Centre Wales Management Centre, Suite 2 376, Newport Road Cardiff CF23 9AE or e-mail recruitment@ecwales.org.uk

LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355

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