Museum of London Application and Diversity Form CfA copy 11215 by 7m4ysl36

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									                            APPLICATION FOR EMPLOYMENT
                                       FOR OFFICE USE ONLY

                                       Candidate reference ID:




Please read the accompanying Information for Applicants thoroughly and use black ink or typescript when
completing this form. If you would like a large-print or Braille version of this form please contact the Human
Resources Department on 020 7814 5792.

SECTION 1

In order to monitor the effectiveness of our diversity policy, please complete the following
questions. Section 1 will be removed by Human Resources before shortlisting and will be kept
strictly confidential. It will not be used as part of the selection process.

Only with a wide range of backgrounds, experiences, perspectives and cultures can we bring London's
diverse histories to life and truly reflect the city and its people today.

As a member of the Employers’ Forum on Disability, we encourage applications from applicants
with disabilities and will interview all who meet the minimum criteria for a job vacancy.

A POSITION DETAILS
   Post applied for:                                    Advert reference Number:


   How did you hear about this vacancy? Please state the name of the publication, website etc:


   Please state any dates that you are not available for interview:


   Are you related to or close friends with any member of staff at the Museum of London? If yes please
   provide details:
   Are you currently or have you ever been employed by the Museum of London?
   Yes           No
B PERSONAL DETAILS
  Title:                                                First name:

   Surname:                                             Surname at birth (if different):

   Address:                                             Preferred contact telephone:

                                                        Second contact telephone:

                                                        Email address:

   Postcode:                                            National Insurance number:
Entitlement to work in the UK
Do you need a work permit to take up employment in the UK?
Yes
No

If ‘Yes’, do you have or have you applied for a permit?
Yes
No

If ‘Yes’ please provide details:




Gender                                            Date of birth:
Male
Female                                            Place of birth:

Marital status
Married                                           Widowed
Divorced                                          Separated
Civil Partnership                                 Single
(Same Sex Marriage)

Religion and belief (optional)
Do you have a religious belief?
Yes (please specify)                              No


Ethnic origin                                     C Asian or Asian British:
A White:                                            Indian
  British                                           Pakistani
  Irish                                             Bangladeshi
  Any other white background (please specify)       Any other Asian background (please specify)



B Mixed:                                          D Black or Black British:
  White & Black Caribbean                           Caribbean
  White & Black African                             African
  White & Asian                                     Any other black background (please specify)
  Any other mixed background (please
  specify)
                                                  E Chinese or other ethnic group:
                                                    Chinese

                                                  F Any other background (please specify)

Sexual orientation (optional)
Bi-sexual                                         Gay male
Heterosexual                                      Gay female
Disability
Do you consider yourself to have a disability?
Yes                 No

If ‘Yes’, please give details and indicate whether you would need any help, support or special
equipment to enable you to carry out the duties outlined in the job description.




Rehabilitation of Offenders

1. Do you have any convictions that are unspent under the Rehabilitation of Offenders Act 1974?
Yes                  No

2. Are you on probation, on a conditional discharge or ‘bound over’ after being charged with any
offence?
Yes                   No

3. Are you insolvent?
Yes                   No

4. Is a Receiving Order in effect on your property?
Yes                   No

5. Are you an undischarged bankrupt?
Yes                  No

For posts that require an Enhanced Criminal Records check (see Information for Applicants)
please answer the following questions:

6. Do you have any convictions that are spent under the Rehabilitation of Offenders Act 1974?
Yes                 No

7. Are you on any sex offenders registers either in the UK or abroad?
Yes                  No

8. Are you aware of any police enquires undertaken following allegations made against you, which may
have a bearing on your suitability for this post?
Yes                  No

If you have answered ‘Yes’ to questions 1, 2, 6, 7 or 8 please give further details below and, if
applicable, the date of the Court hearing, the type of offence, the sentence or order of the Court
and the name and address of the Probation Officer. If you have answered ‘Yes’ to question 5
you should give details of the date of the proceedings and the place at which they were held.




May we approach the Court concerned?
Yes                        No
                                Application for Employment
                                        FOR OFFICE USE ONLY

                                        Candidate reference ID:

                                        Dates candidate not available for i/v:



SECTION 2
C CURRENT EMPLOYMENT (or most recent post held)
  Job title:                                 Date appointed:

                                                        If applicable, date of leaving:
   Name of organisation and type of business::          Period of notice required by employer/leaving
                                                        date:

                                                        Reason for leaving:

   Postcode:                                            Present/ last salary:

   Key responsibilities:




D PREVIOUS EMPLOYMENT (continue on a separate sheet if necessary)
  Dates (from/to) Name of organisation Job title and key responsibilities         Reason for leaving
                  and type of business
E EDUCATION (continue on a separate sheet if necessary)
  Please note you will be required to provide original copies of your highest level qualification and/or any
  qualifications required for the post.
   Dates (from/to)    Schools, colleges and         Subject(s)             Level(s)           Grade(s)
                      universities attended
F ANY TIME NOT ACCOUNTED FOR ABOVE (e.g. unemployment, travel, caring responsibilities etc)
    Dates (from/to)    Reason




G OTHER TRAINING AND QUALIFICATIONS
  Dates (from/to)  Where attended Subject(s)                           Qualifications gained, membership of
                                                                       professional associations etc




H OTHER SKILLS
    Please give details of any other skills or interests you have (e.g. PC skills, languages, published work,
    association memberships etc).




I   REASON FOR APPLICATION
    Please use this section to tell us briefly what motivated you to applying for the post.
J   SUPPORTING STATEMENT
    Please use this section of the form to describe how you meet each of the criteria as listed in the Person
    Specification (continue on separate sheets if necessary).
    Essential:
Desirable:
K REFERENCES
  These must be professional referees and must include your current or most recent employer.
  Your present employer will only be contacted with your consent and will normally only be after a
  verbal offer has been made.
    Name:                                                  Name:

    Job Title:                                             Job Title:

    Address:                                               Address:




    Relationship to you:                                   Relationship to you:

    Telephone:                                             Telephone:

    Email:                                                 Email:

    May we approach this referee prior to making an        May we approach this referee prior to making an
    offer of employment?                                   offer of employment?
    Yes                         No                         Yes                         No


L   DECLARATION
    I understand and agree that any appointment offered would be conditional to the verification (to the
    Museum’s satisfaction) of the information provided on this form and that this information, and that
    contained on any attached documents is true and complete to the best of my knowledge. I also
    understand that it may be a criminal offence to attempt to obtain employment by deception and that any
    misrepresentation, omission of a material fact or deception will be cause for immediate cancellation of
    consideration for employment, or for dismissal if already employed.

    I authorise the Museum of London to process my personal data taken from this form both manually and
    electronically as part of the recruitment process and, if appointed, as part of the employment record.

    If I am successful for appointment I hereby authorise the Museum of London to verify information on this
    form and to the extent permitted by law. I also authorise the Museum of London to perform reference
    checks of my employment as indicated.

    I acknowledge and understand that the appointment will be subject to satisfactory references and will be
    subject to either a Basic Disclosure check or a Standard or Enhanced Criminal Records Bureau
    Disclosure if the nature of the position means it is exempt from the Rehabilitation of Offenders Act 1974.

    If you are returning this form electronically and unsigned you will be required to sign a copy at interview.




    Signed:                                                Date:

    Please return the completed form by the closing date to:

    Postal - Client Services, Cf Appointments, 52-54 Gracechurch Street, EC3V 0EH
    Email – enquires@cfappointments.com           Fax – 020 7220 0181

								
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