Application Form

Nottingham Lakeside Arts
University Park
Nottingham
NG7 2RD

Application for the post of:

Please fill in this form as fully as possible.

SECTION 1 – Personal Details

Mr/Mrs/Ms/Miss:
Forename(s):
Surname:
Home Address: / Present Address (if different):
Home phone number:
Mobile number:
Email address:

SECTION 2(a) – Present/Last Employer

Present/Last Employer (please delete as appropriate)
Name and Address of Employer / Position Held and Brief Description of Duties / Dates position held
Notice period / Salary/Wage:
Reason for Leaving/Wishing to Leave:

SECTION 2(b) – Previous Employment (most recent first)

Name and Address of Employer / Position Held / Dates position held / Reasons for leaving

SECTION 3 – Education/Training (most recent first)

Please list any relevant training courses as well as academic history in this section

Institution / Course Title / Date(s) taken / Grade Achieved

SECTION 4 – Additional Information

Please state clearly why you are applying for this post and how your experience, training, or outside interests may be helpful. Try to address the personal specification where appropriate (continue on a second page if necessary).

SECTION 5 – Rehabilitation of Offenders Act 1974

Please declare any criminalconvictions against you, excluding any convictions which are “spent” under the above Act.

SECTION 6 – References

Please five details of TWO persons from who references may be requested for your application

Reference 1
Name:
Address: / Job Title:
Phone number:
Email address:
Reference 2
Name:
Address: / Job Title:
Phone number:
Email address:

PLEASE NOTE that references will be taken up for applications shorts-listed for interview.

SECTION 7 – Declaration

The data on this application form will be used for the purpose of personnel administration and legitimateissues relating to employment. The University will observe the principles of the Data Protection Act 1998 at all times.
I confirm that the details given by me in this application are accurate. I understand that any false statement or failure to disclose information, where required to do so will if engaged, render me liable to disciplinary action which may include dismissal.
Signed: ………………………………………………………………………………Date:…………………………………………..

EQUAL OPPORTUNITY MONITORING

Application for the post of:
Applicant’s Full Name:
Ref:

LAKESIDE IS AN EQUAL OPPORTUNITY EMPLOYER. It is our intention to ensure that job applicants and staff are treated solely on the basis of their merits, abilities and potential, regardless of gender, race, colour, nationality, ethnic or national origin, age*, socio-economic background, disability, religious or political beliefs, trade union membership, family circumstances, sexual orientation or other irrelevant distinction.

This information is used to assist us in monitoring the effectiveness of our policy and WILL NOT be taken into consideration for short-listing and interviewing purposes. In accordance with the Data Protection Act 1998, Lakeside will seek your explicit permission should it intend to process any sensitive personal data for any reason other than Equal Opportunity purposes or exercising a legal right or obligation required by law. Sensitive data includes your racial or ethnic origin, sexual life, political beliefs, trade union membership, religious beliefs, physical or mental health and criminal offences.

COMPLETE THE FOLLOWING

  1. Sex (please tick)
/ Male  Female 
  1. Date of Birth
/ Age:
  1. Disability
Do you have a disability?
If yes, please give details:
Do you have any condition which requires special working arrangements to be made?
If yes, please give details:
/ Yes  No 
Yes  No 
  1. Nationality (please state i.e. French, British, Chinese)

  1. Do you need permission to work in the UK?
/ Yes  No 

ETHNIC ORIGIN

Choose one section from (a) to (f) then tick the appropriate box to indicate your background.

(a)White

British

English

Scottish

Welsh

 Irish

 Please specify any other White background: …………………………………….

(b)Mixed

 White and Black Caribbean

 White and Asian

 Please specify any other Mixedbackground: …………………………………….

(c)Asian or Asian British (Asian English, Asian Scottish or Asian Welsh)

 Indian

 Pakistani

 Bangladeshi

 Please specify any other Asianbackground: …………………………………….

(d)Black or Black British

 Caribbean

 African

 Please specify any other Blackbackground: …………………………………….

(e)Chinese or Chinese British (Chinese English, Chinese Scottish or Chinese Welsh)

Chinese

 Please specify any other Chinesebackground: …………………………………….

(f)Please specify any other background not listed …………………………………….