APPLICATION FORMCOMPANY NAMEPlease complete this form legibly and return it on or before the closing date specified in the advertisement. Late applications will not be considered. ONLY INFORMATION PROVIDED ON THIS APPLICATION FORM WILL BE CONSIDERED BY THE PANEL. Curriculum vitae will not be accepted. Candidates will outline clearly how their qualifications and experience meet both the essential and preferred requirements. All information given will be treated with the strictest confidence. Continuation sheets may be added if necessary.1. POSITION APPLIED FOR REFERENCE NUMBER2. PERSONAL DETAILSSurname: Telephone number (Home):Forenames: Telephone number (Mobile)Dr/Mr/Mrs/Ms: Telephone number (Work):Address:Postcode:Do you have the right to work in the UK?Note: the company will require proof of this right before an offer of employment can be confirmed eg. Birth certificate and/or any other appropriate document required to confirm your right to work in the UK as required by the Asylum and Immigration Act 1996Yes NoDo you have a clean, current driving licence? Yes No Have you a car/ access to a car for business use?Yes No 3. EDUCATIONFrom To Type of School(i.e. Grammar/ Secondary)Examinations taken and Qualifications Gained(Specify Grades) 4. FURTHER/ HIGHER EDUCATIONFrom To Name of Institution(state if Full or- Part Time)Subjects Taken and Qualifications Gained (Specify Grades or Degree Class Obtained)5. MEMBERSHIP OF PROFESSIONAL ORGANISATIONSDate Joined Institute/ Organisation Grade Of Membership (Where appropriate)6. EMPLOYMENT RECORD (Please list chronologically, starting with current or last employer)Name and Address of Employer and Nature of Business:From: To:Job Title:Job Function/ Responsibilities:Final Salary and Reason for Leaving7. TRAININGDetails of training courses attended and awards achieved, including dates, if appropriate8. SUITABILITY FOR THIS POSITION Please detail your suitability for this position under the relevant headings belowCriteria 1 - Insert criteria from Person Specification belowCriteria 2Criteria 3Criteria 4Criteria 59. DISABILITY DISCRIMINATION ACT 1995Section 1 of this Act describes a disabled person as a person with a physical or mental impairment which has a substantial or long-term effect on his/her ability to carry out normal day-to-day activities.Using this definition, would you consider yourself to be disabled? Yes No (please tick as appropriate)If yes, do you require any special arrangements to be made to assist you is called for interview?Please provide details:10.REFEREES Please give the details of two work related referees, including your current or most recent post. Referees will not be contacted without your prior approval. Name: Name:Position: Position:Company: Company:Address:Telephone No.:Address:Telephone No.:Nature of Relationship: Nature of Relationship:11.VERIFICATION OF INFORMATIONI certify that all information which I have provided is correct. I understand that any false information given may result in a job offer being withdrawn.Signature: Date:Please complete the separate monitoring form enclosed.