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									                                                     Private and Confidential

                                                                                                           For Official Use

The Intellectual Property Office is an executive agency of the Department
for Business Innovation and Skills (BIS).

The first part of the assessment is based on the information which you provide in this
form. It is important, therefore, that you include as much information about yourself and
what you have done as possible. This will enable assessors to make a fair and informed
decision on whether to invite you to attend the next stage.

Electronic applications are preferred, however if you are submitting a handwritten application
form, please complete using

Completed application forms should be received by the closing date 16th December 2011
– see website for details.

Please complete each section below:

Post Applied For:                 Associate Patent Examiner                                        Ref No: PE/12

1. Personal Details

 Title (Mr/Mrs/Ms/Miss)


 Forenames (in full):

 Permanent Address:                                                                            Postcode

 Address for letter (if                                                                        Postcode
 different from above):

 Tel: Home:                                             Work:                                  Mobile:


                          Intellectual Property Office is an operating name of the Patent Office
Do you wish to have all correspondence via E-Mail?

YES       NO

Please give dates when you will be unavailable should you be invited to interview

Are you related to anyone currently employed by the Intellectual Property Office?

YES       NO       If "YES" - to whom and your relationship to them.

Where did you see the advertisement for this job?

Have you ever applied for a job at this Office before?                                YES            NO

If “YES” please give details of the approximate date of the application, the title of the post and the

Date                                 Job Title                                                          Outcome      Please tick

                                                                                                  Not Selected for

                                                                                       Selected for Interview

                                                                                           Interviewed but not
                                                                                                   offered post

                                                                                                     Offered post

                         Intellectual Property Office is an operating name of the Patent Office

2. First Degree Qualifications

Title of Degree          Subject         Result e.g 2:1 upper second                            Awarded/Expected
e.g BSc

University or College

Subjects in final examination

Other subjects taken

3. Post Graduate Qualifications

Name of University/College(s)

Attended (Month/Year)                    From                                                To

Title of qualification

                                Intellectual Property Office is an operating name of the Patent Office

Date awarded/expected

4. Professional Qualifications         Professional Qualification                          Date Awarded

5. Scientific/Technical and
Research Papers etc. Published
since last degree awarded

Please give dates and subjects

6. Foreign Languages

Please indicate your written and
spoken proficiency in any foreign
language e.g. Chinese, Mandarin

                              Intellectual Property Office is an operating name of the Patent Office
Educational Qualifications gained at School or in Further/Higher Education

Please list any qualifications that you have been awarded, including vocational and technical
qualifications, e.g. Typing, Shorthand or Audio. The following is a list of some of the qualifications

School Certificate                  SCE                                                       N. Ireland GCSE Exam
GCSE                                Senior Certificate                                        Pitmans
GCE                                 Scottish Leaving Certificate
CSE                                 Scottish Universities Preliminary

This section enables us to assess whether you are eligible to apply. Incorrect completion of the
educational qualifications table will result in your application being rejected.

                                                                         Level of Exam eg
                                                                                                     Name of Examining   Grade/Mark
        Full and correct title of each subject taken and passed          GCSE, GCECSE/SCE
                                                                                                     Board               obtained
                                                                         A Level, Degree
        (Example) Mathematics                                            GCSE                        WJEC                C

Please list details of those exams which you are about to take or have already taken but for which the
results are not yet known.

                                           Intellectual Property Office is an operating name of the Patent Office
7. Employment

Please give details of your career to date, starting with your current/last employer.
(Continue on a separate sheet if necessary)

 Employment history, starting with the most recent.

 Employer’s name and        Job title and brief outline               From          To            Reason for leaving
 address                    of duties

4. Part-Time

If you are seeking part time employment please tick here

We will try to find a suitable part-time post for successful applicants, but some flexibility over hours
may be necessary.

                                Intellectual Property Office is an operating name of the Patent Office
8. Skills and Abilities

Assessment for suitability for these posts will be based on the skills and attributes outlined below.


   Each skill / attribute must have a maximum of 250 words. Additional words may be

   What sort of achievements should I choose?

   Focus on either

            A one off incident which led to a successful conclusion
            An achievement which involved a lot of time and effort.

Remember that you need not necessarily have done these things in a workplace, equally valid are
experiences at university, a social setting or as part of a club/charitable organisation.

It is important to describe clearly the situation YOU were in, what YOU actually did, the result of YOUR
participation and finally THE BENEFITS you feel were gained, either for yourself and/or others. In
other words describe the outcome of YOUR efforts.

Please remember the maximum word limit of 250 words for each area

     1.     Well developed analytic ability; able to analyse, understand and evaluate technically
            complex material

     2.     Strong written and oral communication skills; the ability to communicate effectively
            with staff, senior colleagues and user interests in a variety of forms (written, face to face,

     3.     Ability to organise and prioritise workload – able to manage conflicting priorities and
            handle a variety of tasks and targets

     4.     A good team player; the ability to get on with people, use your skills and knowledge to
            help others

     5.     Additional information. Please provide any other personal details which you feel could
            support your application.

                                Intellectual Property Office is an operating name of the Patent Office

We will be taking up references, we would therefore like you to provide the names and addresses of
two referees, one of whom should be your last employer, or your year tutor from university or college.

                               Intellectual Property Office is an operating name of the Patent Office
Personal Information/Monitoring

Important Notes

Please read carefully:

   If you give any particulars which you know to be false or if you withhold information, you
    may render yourself liable to disqualification, or, if appointed, to dismissal.

   Do not send educational certificates, whether copies or originals.

   The Intellectual Property Office’s recruitment processes are underpinned by the principle of
    selection for appointment on merit on the basis of fair and open competition as outlined in the Civil
    Service Commissioners' Code which can be found at:

Availability for Appointment

If offered the appointment, when could you start?

Do you need to give notice                       Yes                              No

If “Yes” how much notice do you need to give?

                               Intellectual Property Office is an operating name of the Patent Office
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. The personal information that you give us will also
be used in a confidential manner to help us monitor our recruitment process.

If you succeed in your application and take up employment with us, the information will be used in the
administration of your employment with us and to provide you with information about us or third party
via your payslip. 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 we will be assuming that you agree to the processing of sensitive
personal data, (as described above), in accordance with our registration with the Data Protection

I declare that the information I have given is, to the best of my knowledge, true and complete.

Signature:                                                                         Date:

Electronic applications are preferred. If you return your application by e-mail you will be
required to sign it, should you be invited to interview.

Applications can be returned preferably by e-mail to: or a hard copy of
your application can be returned to:

Julia Tully
Patent Examiner Recruitment
Room 3R50
Intellectual Property Office
Concept House
Cardiff Road, Newport,
South Wales. NP10 8QQ.

                                Intellectual Property Office is an operating name of the Patent Office

   Place of birth                 Country:
   What is your present nationality:
   Nationality at birth:

   Are you a British Citizen by birth, naturalisation or other?

   Please give your certificate number

   Birth            Naturalisation                     Other

   Have you ever possessed or acquired
   nationality or citizenship of any                    Yes                      No
   country other than the UK?

   If Yes please give details

   What is your Alien’s
   Registration Number
   (If applicable)

Are you subject to immigration control?                                  Yes                             No

   Are you free to live and work in this country?                        Yes                             No

   If you are successful in your application,
   would you require a work permit prior to                              Yes                             No
   taking up employment?

Note. If you are appointed, documentary evidence will be sought to confirm your answers.
Your answers may, additionally, be checked against UK immigration and nationality records.

                                Intellectual Property Office is an operating name of the Patent Office
Disability Declaration

Application for a guaranteed interview for people with disabilities.

Intellectual Property Office actively encourages applications from people with disabilities.

Applicants with disabilities who meet the published minimum criteria for the job will be guaranteed an

The Disability Discrimination Act 1995 defines a disabled person as someone who has:

A physical or mental impairment which has a substantial and adverse long-term effect on his or her
ability to carry out normal day-to-day activities.

Please identify the type of disability you have:

If it is not obvious, please give details of how it affects you:

If you would benefit from any special service, ie. Information in Braille or large print, a lip reader or sign
language interpreter, Supported Employment Officer or car parking facilities, please let us know and
we will do all we can to meet those needs.

Any false declarations of disability to obtain an interview may invalidate your contract of employment.

                                 Intellectual Property Office is an operating name of the Patent Office
Diversity Survey

As an employer committed to pursuing equality of opportunity, the Intellectual Property Office wants to
ensure that all applicants are treated equally whatever their age, gender, sexual orientation, religion,
nationality or ethnicity. We would, therefore, be grateful if you would answer the following questions.
Your answers will be treated confidentially and will not affect your application in any way. Please
remember to put a cross in a box in both the nationality and ethnicity sections

1. What is your Gender?                                          3. What is your Nationality?
(A) Male                                                         (A) British or Mixed British
(B) Female                                                       (B) English
                                                                 (C) Irish
2. What is your Date of Birth?                                   (D) Scottish
                                                                 (E) Welsh
                                                                 (F) Other
                                                                 Please specify:

4. What is your Ethnicity?
Asian                                                            Mixed Ethnic Background
(A) Bangladeshi                                                  (I) Asian and White
(B) Indian                                                       (J) Black African and White
(C) Pakistani                                                    (K) Black Caribbean and White
(D) Any other Asian Background                                   (L) Any other Mixed Ethnic Background
Please specify:                                                  Please specify:
Black                                                            White
(E) African                                                      (M) Any White Background
(F) Caribbean                                                    Please specify:
(G) Any other Black Background
Please specify:
Chinese                                                          Any other Ethnic Background
(H) Any Chinese Background                                       (N) Any other Ethnic Background
Please specify:                                                  Please specify:

5. What is your Religion?                                        6. What is your Sexual Orientation?
(A) Christian                                                    (A) Bisexual
(B) Buddhist                                                     (B) Heterosexual
(C) Islam                                                        (C) Lesbian / Gay
(D) Hindu
(E) Judaism
(F) Parsi (Zoroastrianism)
(G) Sikh
(H) Jain
(I) None
(J) Other
Please specify:

                               Intellectual Property Office is an operating name of the Patent Office

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