Word corporate colour template

RNIB Application Form1. Personal details

Forename(s) or given name:

Surname:

Please state your preferred title (i.e. Mrs, Miss, Mr, Dr):

Position for which you are applying:

Location:

Vacancy reference number:

Home address:

Postcode:

Telephone (home):

Telephone (mobile):

Telephone (work):Email:

Right to Work in the UK: YES / NOPlease note that we are only able to employ people who have the right to work in the UK.

2. Career HistoryPlease provide us with a brief history of your work over the last 10 years, explaining any gaps. Current Employment

Employer's Name and Address:Dates Employed:

Job Title:

Reason for leaving:Brief overview of responsibilities:

Current Salary:

Previous Employment

Employer's Name and Address:Dates Employed:

Job Title:

Reason for leaving:Brief overview of responsibilities:

Please continue to provide your most relevant career history in the same format.

3. Supporting StatementPlease tell us how you meet the criteria in the person specification, paying particular attention to that which is asked for in the advert. Please also include any relevant qualifications or memberships of any professional bodies if these have been asked for in the person specification.4. Specific requirements

Preferred reading format Braille / Audio tape / Disk / Print / Email / Large Print (if large print, please specify print size):

Please let us know any specific requirements you will need if you are invited for interview:

5. Have you ever been convicted of a criminal offence?

(Declaration subject to the Rehabilitation of Offenders Act 1974)

If your answer is yes, please give details of date(s) of offence(s) and sentence(s) passed, which are not spent.

6. Have you ever worked for RNIB?

If yes, please provide details of the date, role, location and reason for leaving:

7. If selected when would you be available to take up employment with RNIB?

8. References

All offers of employment are subject to receipt of satisfactory written references. Please provide the names, addresses, telephone numbers and email addresses of two referees, both of whom should be previous employers, including your present or most recent employer. If you have not been employed previously, or have only had one job you may nominate an academic referee and/or someone of standing in the community who knows you e.g. Doctor, Solicitor. You may also nominate a referee from any voluntary work you have undertaken.

Referees will not be contacted without your prior permission. Please ensure contact details are up to date.

Name:

Position:

Address:

Telephone:

Email:

What is your connection with this referee?

May we approach this referee prior to interview? Yes/No:

Name:

Position:

Address:

Telephone:

Email:

What is your connection with this referee?

May we approach this referee prior to interview? Yes/No:

9. Declaration

I declare that the information provided on this form is correct to the best of my knowledge and understand that any information submitted in connection with employment and subsequently found to be incorrect or deliberately misleading could lead to my dismissal without notice.

Signed:

Date:

Please note:

When emailing your application a hand-written signature is not necessary.Logo RNIB supporting blind and partially sighted people

Registered charity number 226227