Ground Floor, 21 Southampton Row, London, WC1B 5HA
+44 (0) 20 7269 0740
Please complete this form in type or black ink, for photocopying purposes, and return it with the recruitment monitoring form by e-mail or by post to the above address.
Personal Details
Title / Surname / Forenames in full
Do you hold a valid work permit for this post?
YesNo
Address
Postcode / Day Telephone
Evening Telephone
Mobile
The Disability Discrimination Act 1996 defines disability as a ‘physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out normal day-to-day activities’.
Based on this definition, do you consider yourself to have a disability?YesNo
Afrikids is an equal opportunities employer welcoming applications from all people and answering yes to this question will in no way affect the outcome of your application. If you answered yes, Afrikids would be grateful if you could indicate whether you would need any reasonable adjustments to be made, or support provided, if you were invited to interview/offered the post.
Referees
Please give below the names and contact details of two people from whom references may be sought, at least one of whom should have recent knowledge of your work; your current employer should normally be included. References will only be taken up for successful candidates.
Name
Positionheld
Organisation / Address
Telephone
Name
Positionheld
Organisation / Address
Telephone
Fair Recruitment
To ensure a fair recruitment process are you, to your knowledge, related to or know any employee or Trustee of AfriKids?
YesPlease specify relationship and with whom:
No
Employment History
Present employer (or last employer, if not currently employed).
Name of employer / Post held
Present salary and grade / Date of appointment
Reason for leaving / Period of notice
Please give a brief description of your present duties and responsibilities
Previous posts (most recent first). Please account for any gaps where you have not been in employment.
Name of employer / Post held / From / To
Duties and Reason for leaving
Name of employer / Post held / From / To
Duties and Reason for leaving
Name of employer / Post held / From / To
Duties and Reason for leaving
Name of employer / Post held / From / To
Duties and Reason for leaving
Education and Training
Secondary, further and higher education
School, college, university etc. / Subjects taken/qualification or grade archived
Additional qualifications, training and short courses relevant to the post
Membership of professional bodies
Statement in Support of Application
Please state why you would like to work for AfriKids and why you believe you are a suitable candidate for this position by explaining how you meet its requirements and the experience which you have that is relevant. Please give examples of particular achievements.
Declaration and Data Protection Act
In accordance with the Data Protection Act 1998, the information provided on this form will be used in the recruitment and selection process and may be disclosed to all those who need to see it. It will also form the basis of the confidential personnel record of the successful candidate. In the case of unsuccessful candidates the information will be destroyed after twelve months. In addition, it will be held on a database and used for equal opportunities monitoring purposes.
I confirm that I do not object to the information collected on this form being held electronically for the purpose of anonymous statistical reporting, and to assist AfriKids in equal opportunities monitoring in respect of job applications.
I agree that AfriKids has the right to validate any of the information provided.
I certify that to the best of my knowledge, the information given on this form is correct.
Signature:Date:
Please note that if you are sending this application form via e-mail you will be required to sign the form if you are invited to an interview.
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