The Food and Environment Research Agency (Fera) Job Application by mallorycarlson


									                      The Food and Environment Research Agency (Fera)
                                    Job Application Form

 Post details

Job title

CSP ref                                                Our ref

Closing date

 Personal details



Any other names
by which you
are known

Email address


Permanent address                             Correspondence address
                                              (if different from permanent address)

                           Postcode                                   Postcode

 Telephone numbers

Home                                             Mobile

JA1 (Fera) (REV. 08/09)                                                               1
 Education and qualifications

N.B. Examination certificates must NOT be sent with this application. SHOULD you be invited to
an interview, you will be asked to produce the original certificates, not copies.

 Name of educational            Qualifications and subject               Date          Grade
 institution                    (e.g. GCSE Maths, BSc Hon Chemistry)    awarded /

 Other information
 (i.e. additional qualifications not outlined above, or details of any membership of
 professional institutions)


If relevant to the position, please attach publication record
Tick if attached          Yes   No

JA1 (Fera) (REV. 08/09)                                                                         2
 Work history
 Current (or most recent employer)

Employer’s name:



Notice period:

Contact number:


Dates:                     From:                 To:

Salary details:            £         per annum

Nature of business:
Main duties and responsibilities:

JA1 (Fera) (REV. 08/09)                                     3
 Work history (continued)



Job title:

Dates:                      From:                              To:

Main duties:

Reason for leaving:



Job title:

Dates:                      From:                              To:

Main duties:

Reason for leaving:



Job title:

Dates:                      From:                              To:

Main duties:

Reason for leaving:

Please attach a separate sheet if necessary. Attached sheet   Yes     No

JA1 (Fera) (REV. 08/09)                                                    4
 Qualifications, skills, experience and competencies
 Please describe (in no more than 500 words) how you meet the qualifications,
 skills, experience and competencies required for this role. This can be through work,
 home or voluntary activities. Please do not use an additional sheet or the Further
 Information section as a continuation of this section.

JA1 (Fera) (REV. 08/09)                                                                  5
 Further information

 Dates not available for interview


Please provide details of at least two referees not related to you, who have consented to be

 Previous/current employer

Occupation/job title:

Full postal address:





May we obtain this reference now?        Yes      No

JA1 (Fera) (REV. 08/09)                                                                        6
 Character referee

Occupation/job title:

Full postal address:





May we obtain this reference now?             Yes        No


I declare that the information I have given in support of my application is to the best of my knowledge
and belief, true and complete. I understand that if it is subsequently discovered that any statement is

If this box is left blank your application form will not be accepted.

 Declaration box                                     Date

JA1 (Fera) (REV. 08/09)                                                                                   7
                          This page has been left intentionally blank.

JA1 (Fera) (REV. 08/09)                                                  8
The information supplied in this section is for recruitment monitoring purposes only, and will not be used
in the selection process.

                                  Recruitment Monitoring Form

Name:                                                                        CSP ref:

 Part 1: Nationality
This post is open to UK nationals, other Commonwealth citizens, British Protected Persons and nationals
of states in the European Economic Area (EEA) and certain non-EEA family members. Commonwealth
citizens must be free from any restrictions to reside and take up employment in the UK. If you are unsure
of your status, please explain your circumstances in a covering letter. For further information, please see
the following website:
or refer to the information in your application pack.
Please complete the following questions before proceeding with this application.

Nationality at birth

Present nationality

Have you ever possessed any other nationality or citizenship? Yes                No      (Please tick)

If yes, please give details

Are you subject to immigration control? Yes           No        (Please tick)
Are you free to remain and take up employment in the UK? Yes                No        (Please tick)

 Part 2: Equality Monitoring
The Food and Environment Research Agency (Fera) is committed to equality of opportunity for all staff to
develop their potential and to use their abilities to the full. We want to ensure that all applicants are treated
equally regardless of race, gender, disability or religion. Completing the questionnaire will help us to do this

statistics from this survey will help to ensure that Fera treats all applicants fairly and equally.

as part of your personal data on the Fera HR database, in accordance with the provisions of the Data
Protection Act. Access to this information is highly restricted and is only used for monitoring purposes,
which never identify individuals.


Male               Female


Date of birth:                                                Age:

JA1 (Fera) (REV. 08/09)                                                                                         9

 Marital Status

Single                                                     Civil partnership
Married                                                    Cohabiting

Which group do you most identify with? (Please tick only one option)
(A) British or Mixed British                           (D) Scottish
(B) English                                            (E) Welsh
(C) Irish                                              (F) Or any Other

Which is Your Ethnic Background? (Please tick only one option)
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
Black                                                  White
(E) African                                            (M) Any White background
(F) Caribbean                                          Any other Ethnic Background
(G) Any other black Background                         (N) Any other Ethnic background
(H) Any Chinese background


Am I disabled, as defined by the Disability Discrimination Act (DDA)?
                                                                                                or have
had in the past), a physical or mental impairment which has a substantial and long-term adverse effect
(lasting or likely to last 12 months or more) on their ability to carry out normal day-to-day activities.
If you have been diagnosed with cancer, HIV or multiple sclerosis you have rights under the DDA
from the date of diagnosis. You do not have to demonstrate that there is a substantial and long-term
adverse effect on your ability to carry out normal day-to-day activities.
What sort of support could I expect if I am disabled?
We would take steps to meet your particular needs. This might for example be providing forms in
alternate formats, extra time in tests or at interview, or provision of a BSL signer.
Once employed, it could be the provision of different furniture or equipment, or making adjustments to
your working pattern or job redesign. We can arrange professional advice to agree with you what will
make you comfortable and productive at work.

Do you consider yourself to have a disability? Yes        No

JA1 – Appendix (Fera) (REV. 08/09)                                                                       10
What would be the biggest barriers for you in doing what you want to do in this organisation?
Please indicate the barriers that apply:

Access to transport

Access to buildings

Visual communications

Audible communications

People’s attitudes

Policies or procedures

Other barrier (please specify)

If you are disabled please give further details of your disability:

Describe any special arrangements that you require for the assessment process:

I agree that the interview panel can be told that I am disabled and the nature of the barriers that
I may face.

Please sign


I do not want information passed onto the interview panel. I understand that if information is not passed
on I may not get all of the support that I may need.

Please sign

 Sexual Orientation
Please tick the box that applies:

Heterosexual                                                  Gay man
Gay woman/lesbian                                             Bisexual


Why do we monitor sexual orientation?
Since 2003, it has been illegal to discriminate at work on the grounds of sexual orientation. Fera will not
tolerate discrimination on any grounds and we therefore want to monitor discrimination based on sexual
orientation. Current evidence suggests that 45% of organisations take part in Workplace Equality Index
monitor at all grades.

JA1 – Appendix (Fera) (REV. 08/09)                                                                          11

Fera is continually looking to evaluate how effective its recruitment advertising is.
Could you please indicate where you first saw this vacancy advertised.

Fera website                                        Fish4jobs website
                                                    Job Centre
Civil Service
Recruitment Gateway                                 Free Local Paper
                                                    e.g. York Star
The York Press –                                    Word of mouth –
Advert                                              personal recommendation
New Scientist                                       Other – please state

 Return address for applications

                          The Food and Environment Research Agency (Fera)
                                            Room 11G02
                                            Sand Hutton
                                             YO41 1LZ

JA1 (Fera) (REV. 08/09)                                                                 12

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