APPLICATION FORM

PRIVATE AND Confidential

Please complete this application form, save it as a pdf and rename with your name and the reference SG as the file name. Then email to Sarah Fussell, Operations Manager at . If you cannot do this please post it to Sarah Fussell, The Story Museum, Rochester House, 42 Pembroke Street, Oxford OX1 1BP.

JOB TITLE Story Guide

PERSONAL DETAILS

Name

Address

Post Code

Phone Daytime Evening

Email

National Insurance Number

I confirm that the details given on this form and any other information I have provided in support of my application for employment are complete and correct. I understand that giving false or misleading information, or failing to provide details, will invalidate an offer of employment.

Signed

Date


SUITABILITY FOR POST

With reference to the job description and person specification please explain with examples from your experience why you think you would perform well in this job.

Please continue on a separate sheet if necessary
EMPLOYMENT DETAILS

PRESENT OR MOST RECENT EMPLOYER

Name and Address of Employer:
Position held
Dates
Current Salary
Summary of Responsibilities
Reason for Leaving and Notice Period

If not currently employed please state your current situation:

SUMMARY OF PREVIOUS EMPLOYMENT HISTORY

Name of Employer / Dates / Job Title and Responsibilities / Reason for Leaving


EDUCATION, QUALIFICATIONS AND TRAINING

Please list education and training undertaken, starting with the most recent. Please also include membership of any professional organisations.

Institution/organisation
and address / From / To / Qualifications gained, with grade


REFERENCES

Please give the names and addresses of two work-related referees (not relatives or friends) who can provide direct knowledge (eg Line Manager) of your work performance and attendance record. One must be your must current or most recent employer.

REFEREE 1 / REFEREE 2
Name / Name
Position / Position
Address / Address
Telephone / Telephone
Email (this is important) / Email (this is important)
Do we have permission to contact this referee before the interview?
Yes/No / Do we have permission to contact this referee before the interview?
Yes/No

Have you ever been convicted of any criminal offences which are not yet ‘spent’ under the Rehabilitation of Offenders Act 1974?

Yes/No

How did you hear about the vacancy?

It is not compulsory, but it would be very helpful if you could complete the Recruitment Monitoring Form on the next page. It is not used as part of the selection process in any way.

RECRUITMENT MONITORING FORM

PRIVATE AND CONFIDENTIAL

The Story Museum is committed to recruitment on merit and to promoting equality of opportunity. By completing this form you will provide information that can be used to monitor our effectiveness in achieving those objectives.

This form should be returned with your application but will be separated on receipt. The information provided will be treated as confidential and will not be used as part of the selection process.

JOB TITLE Story Guide

1. Are you: Female/Male

2. Do you have a disability? Yes/No/Decline to specify

(If yes, please answer question 3)

3. Please tick one or more boxes to describe your disability:

[ ] Specific learning difficulty (eg dyslexia)

[ ] Blind/partially sighted

[ ] Deaf/hard of hearing

[ ] Wheelchair user/mobility difficulties

[ ] Asperger’s syndrome

[ ] Mental health difficulties

[ ] Unseen disability (eg diabetes)

[ ] Other

4. Nationality UK/Other EC/Other

If not UK please specify

5. How long have you lived in the UK? (please tick one box only)

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Application Form SM-SG-17

[ ] I do not currently live in the UK

[ ] I have always lived in the UK

[ ] Less than 1 year

[ ] 1-4 years

[ ] 5-10 years

[ ] 11-20 years

[ ] 21+ years

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Application Form SM-SG-17

6. Age (please tick appropriate box)

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Application Form SM-SG-17

[ ] 18-25 years

[ ] 26-30

[ ] 31-35

[ ] 36-40

[ ] 41-45

[ ] 46-50

[ ] 51-55

[ ] 56+

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Application Form SM-SG-17

7. Ethnic origin (please tick one box only)

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Application Form SM-SG-17

White

[ ] British

[ ] Irish

[ ] Any other White background (please specify)

Black or Black British

[ ] Caribbean

[ ] African

[ ] Any other Black background (please specify)

Chinese

[ ] Chinese

Other ethnic group

[ ] Any other

[ ] Decline to specify

Mixed

[ ] White and Black Caribbean

[ ] White and Black African

[ ] White and Asian

[ ] Any other mixed background (please specify)

Asian or Asian British

[ ] Indian

[ ] Pakistani

[ ] Bangladeshi

[ ] Any other Asian background (please specify)

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Application Form SM-SG-17

Thank you

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Application Form SM-SG-17