Creswell Heritage Trust

CRESWELL HERITAGE TRUST

Post Applied For –

Limestone Journeys Scheme Manager

IF FURTHER SPACE IS REQUIRED IN COMPLETING ANY SECTION OF THIS FORM, PLEASE ATTACH SEPARATE SHEETS

Personal Details
Surname
Forename(s) or other names
Address for correspondence
Telephone
E-mail address
Other contact
Fax
National Insurance No.
(if known)
Do you need a work permit to take up this appointment? / Are you a UK or EU/EEA national?
Please give details of any dates that you would not be available for interview:
Education / Please continue on a separate sheet if necessary
Secondary School / From / To / Qualification gained, subject, grade and date
Further, Higher and/or Professional Education / Qualifications Achieved
College/University / From / To / Subject courses studied, level and grade
Professional Membership/Awards (include name of institution/organisation, grade of membership and date of award)
Vocational/Other Training Courses (include name of institution, nature of course and date)
Employment History / Present or most recent employment
Name, Address and Telephone No of Employer / Date(s) employed / Salary and Review Date / Position(s) held
Former Employment / Please list in chronological order, with your most recent post first
Name, Address and Telephone No of Employer / Dates(s) employed / Position(s) held and outline of duties and responsibilities / Reason for Leaving
Additional supporting information
Any other relevant information:
Please state how previous and present experience would enable you to perform this role. (continue on a separate sheet if necessary).
References - please tick the box below if you do not want your referee to be contacted prior to interview / Please supply the name and address of two persons for references. Referee 1 must be your current or most recent employer. If you have not previously been employed then Head Teacher/College Lecturer/Head of Voluntary Organisation etc are acceptable as referees.
Referee 1 / Name
Position
Address
Tel
Email
Referee 2 / Name
Position
Address
Tel
Email
General Information:
Are you a holder of a clean current driving licence?
Do you own a car?
Are you related to a Member of the Council of Management of the Trust, or to an employee of the Trust? (If so, please give details)
Where did you see the advertisement? (Name of place or publication)
Have you ever been convicted of a criminal offence, have you ever been cautioned by the police or are you the subject of criminal charges? (If so, please give details)
Health / Medical Details :
Are you aware of any medical condition or other medical grounds that might affect your ability to carry out the duties in the job description?
If you answered yes please give details:

I declare that the information contained in this application is correct to the best of my knowledge and understand that any false statement or omission may result in my application being withdrawn or my appointment being terminated. Any information provided will be stored in electronic and manual form and processed in accordance with the Data Protection Act (1998).

Signature : / Date:

Please return completed forms to:

Or by post to:

Limestone Journeys Scheme Office

c/o Creswell Heritage Trust,

CreswellCragsMuseum and Education Centre,

Crags Road,

Welbeck, Worksop,

Nottinghamshire,

S80 3LH

Closing Date:Friday 20th March 2014, 5.00pm

EQUAL OPPORTUNITIES
MONITORING FORM

Please ensure that you complete this form

Creswell Heritage Trust is required to keep a record of this data in order to ensure that there is no discrimination in employment practice with regards to appointment, access to training, and promotion. This is a condition under the Data Protection Act under which processing of sensitive data can take place.

Please tick one box in each section. Completing the last two sections is optional.

Gender

Female □Male □

Age group

Under 25 □ 25-34 □ 35-44 □ 45-54 □ 55-60 □ Over 60 □

Ethnicity

White: British□Irish □

Any other White background ……………………………………………………………………………………………………

(please write in)

Mixed:White and Black Caribbean □ White and Black African □ White and Asian □

Any other Mixed background …………………………………………………………………………………………………….

(please write in)

Asian or Asian British:Indian □ Pakistani □ Bangladeshi □

Any other Asian background ……………………………………………………………………………………………………..

(please write in)

Black or Black British:Caribbean □African □

Any other Black background ……………………………………………………………………………………………………..

(please write in)

Chinese or any other ethnic group:Chinese □

Any other ethnic group …………………………………………………………………………………………………………...

(please write in)

Disability

I consider myself to be someone who has a disability:Yes□No□

Religion (optional question)

None □Christian □ Buddhist □Hindu □ Jewish □ Muslim □ Sikh □

Any other religion ………………………………………………………………………………………………………………….

(please write in)

Sexual Orientation (optional question)

Bisexual □Heterosexual □Homosexual □

Many thanks for completing this questionnaire – please be assured all information will be kept in the strictest of confidence