/ 18 Stephenson Way
London NW1 2HD
Tel: 020 7935 0702
Return application via email to:

APPLICATION FORM

/

HR ref:

Title / Surname

Forenames

Please highlight preferred name(s)
Address for Correspondence / Postcode
Contact daytime Tel/Mobile
Contact evening Tel/Mobile
Email address
Date available to commence employment? Please also include any intended holiday booked in the next 6 months.

Current or last salary (per annum)

/ £

Form continued on page 2.

As part of the College’s commitment to equality, diversity and inclusion, applicant’s personal details on page one will not be made available to the selection panel at the shortlisting stage.

HR Ref.

/ (HR use only)

Position Applied For

Employment History (Please list all roles with your present or most recent employment first.) Please continue on a separate sheet if necessary.
Employer and nature of business
Including Address / Dates
(month/year) / Position held and nature of responsibility / Reason for leaving
From / To
Education and Professional Qualifications (most recent first)
Please continue on a separate sheet if necessary.
Dates / Education
Name & address of institution / Qualification & Grade obtained
Successful candidates will be required to produce original certificates.
From / To
Membership of professional institutions

Practical Skills(including IT, secretarial, typing speed, languages etc.)

Interests

Statement in Support of your Application

Please continue on a separate sheet if necessary.
Please indicate clearly why you are applying for this role and how your skills and experience meet the requirements of the post as set out in the Job Description and Person Specification (please feel free to include any voluntary/community experience).
Flexibility Requirements
Ability to work flexible hours beyond the standard 0900 to 1700 when required for meetings and events? Either TOIL or limited paid overtime is available.
YES/NO

Please answer the following questions

Have you previously applied for a post at the Royal College of Ophthalmologists? YES/NO
If yes, for which post(s) have you applied?
Are you currently eligible for employment in the UK?
YES/NO (Please note that work permits will not be sought for ineligible applicants.)
Please state what documentation you can provide to demonstrate this, e.g. British passport/European Economic Area identity card/full birth certificate/passport or travel document showing an authorisation to reside and work in the UK.
Have you ever been convicted of a criminal offence?
YES/NO
If yes, please give details. (Declarations are subject to the provisions of the Rehabilitation of Offenders Act 1974 as amended.)

Referees

Please give details of two referees who are not related to you.
At least one referee should be your present (or most recent) employer who is able to comment on your work.
1. Name & Title:
Position:
Organisation:
Address:
Email address:
Contact number: / 2. Name & Title:
Position:
Organisation:
Address:
Email address:
Contact number:
Referees will not be contacted prior to interviews.

Declaration

I confirm that I have read and understand the job description and person specification.
I confirm that the information given on this form is, to the best of my knowledge, true and complete. I understand that any false declaration or misleading statement or a significant omission may disqualify me from employment and render me liable to dismissal. I understand that any job offer is subject to references, checks on relevant qualifications, employment eligibility and criminal convictions, a probationary period and (if the organisation believes it appropriate) a medical report, all of which must be deemed by the organisation as satisfactory.
Signature: Date:

Please indicate where you saw this post advertised?

Operational Support/HR/2017 1

Operational Support/HR/2017 1