*Section 1 - PERSONAL DETAILS

PLEASE COMPLETE AND RETURN AS A WORD DOCUMENT.

Job applied for / Senior Researcher 35 or 28 hours / Job ref number / 1736
First name / Surname
Title / Email
Telephone / Mobile
Address and post code
Preferred method of contact
Are you a UK citizen? / YES * NO * / If not, do you have a permit to work in the UK? / YES * NO *


Section 2 - ELIGIBILITY TO WORK IN THE UNITED KINGDOM
To be considered for a role, you will need to have the right to work in the UK or have a valid UK work permit. You will be asked to bring documentation under the immigration, Asylum and Nationality Act 2006 to support your right to work in the UK.
Section 3 - REFEREES
Please give the names of two employment referees, starting with your present or most recent employer. References are only taken up after a provisional offer of employment has been made.

Name / Name
Position / Position
Company / Company
Address / Address
Telephone / Telephone
Email / Email


Section 4 - CURRENT EMPLOYMENT STATUS
Please confirm your current notice period and salary.

Notice Period / Current Salary (£)


Section 5 - DECLARATION
I declare that, to the best of my knowledge, the information given on this form is correct. I understand that providing misleading or false information will disqualify me from appointment or, if appointed may result in my dismissal.

Signed / Date


If you are completing this form electronically and are invited to interview you will be required to sign your application form at that stage.

By completing this form I understand that I give my consent under the Data Protection Act 2003 for this information to be processed in accordance with the NCB policy for the purpose stated above.

Disclosure and Barring Service (DBS) Checks - If your application is successful and you are offered employment with us you may be asked to consent to an Enhanced Disclosure check by the DBS. This is to ensure we safeguard the children and young people we work with. You do not have to consent to these checks being carried out. However, if consent is withheld NCB will have the right to withdraw the offer of employment.
Data Protection Statement - The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process. We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing the application form you are agreeing to the processing of sensitive personal data in accordance with our registration with the Data Protection Commissioner.


EQUAL OPPORTUNITIES FORM
NCB is fully committed to the active promotion of equality and diversity in its employment practices, in the work that it undertakes and in the provision of all its services. NCB treats all employees, service users and the children and young people with whom we engage fairly, irrespective of their age, gender, sexual orientation, ethnicity, faith, disability or impairment, including HIV status and mental health.

NCB needs to record these details which will only be used to fulfill NCB’s equal opportunities obligations and as a guide in building efficient recruitment strategies. The information contained in this form is completely confidential.

1. Where did you hear about this position
2. What position are you applying for? (include job reference) / Senior Researcher (fixed term contract) 1736
3. Your age range (please tick box)
16 – 21 / 22 – 30 / 31 – 40 / 41 – 50 / 51 – 60 / 61 – 65 / 65+ / Prefer not to say
* / * / * / * / * / * / * / *
4. Gender / Male * Female *
5. What is your ethnicity? Ethic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box
White
English * / British * / Welsh * / Gypsy or Irish Traveller * / Scottish * / Northern Irish * / Irish * / Prefer not to say *
Any other white background, please write in:
Mixed/multiple ethnic groups
White and Black Caribbean * / White and Black African * / White and Asian * / Prefer not to say *
Any other mixed background, please write in:
Asian/Asian British
Indian * / Pakistani * / Bangladeshi * / Chinese * / Prefer not to say *
Any other Asian background, please write in:
Black/African/Caribbean/Black British
African * / Caribbean * / Prefer not to say *
Any other Black/African/Caribbean/Black British background, please write in:
Other ethnic group
Arab * / Prefer not to say *
Any other ethnic group, please write in:
6. Do you consider yourself to have a disability? / YES NO PREFER NOT TO DISCLOSE INFORMATION
If ‘YES’ Please state the nature of the disability and whether you need any adjustments to be made in order to be able to carry out this role/interview at the best of your abilities.
7. If you wish, you may disclose information about yourself in this section about your religion and sexual orientation
Religion / Sexual orientation
Date form completed / D / D / M / M / Y / Y


PLEASE RETURN YOUR COMPLETED FORMS TO:

Address / HR Department
NCB, 8 Wakley Street
London, EC1V 7QE
Telephone / 020 7843 6000
Email /