APPLICATION FORM UNIQUE IDENTIFICATION NUMBER (Please leave blank ) GENERAL OPTICAL COUNCIL APPLICATION FOR EMPLOYMENT The information provided on this application form will remain private and confidential and will be used for the purpose of selection/recruitment. Please complete all parts of the form. Where application is successful the organisation may, from time to time, wish to process this information (as updated periodically) for personnel and business management purpose. Where this is the case, processing will take place in accordance with the provisions of the Data Protection Act 1998. Please also note that the GOC may approach third parties to verify the information that you have given. By signing this form you will be providing the organisation with your consent to all these uses. PERSONAL INFORMATION Please refer to the guidance when completing your applications. Post title: Advert reference number: 1. PERSONAL DETAILS Name: Address: Date of birth: Contact details (Please tick preferred contact details – call to business numbers will be made discreetly) Email: Telephone home: Telephone work: Mobile: 2. GENERAL If the job requires it 1. Will you relocate? Yes No 2. Are you willing to travel? Yes No Are there any adjustments that may be required to be made should you be invited for interview? If yes, please give details: Referee 1 Referee 2 Name: Name: Address: Address: Telephone: Telephone: Email: Email: Relationship to you: Relationship to you: Page 1 of 3 APPLICATION FORM I give /do not give permission to take up my references prior to an offer of employment being made (please delete clearly as appropriate). 3 EMPLOYMENT HISTORY Please give details of all jobs held including part time and unpaid work, starting with your current or most recent employer. Name and full address of Job title(s); key responsibilities & key Reason for leaving employer; nature of business. achievements. and date of leaving. 4 EDUCATIONAL, TECHNICAL AND PROFESSIONAL QUALIFICATIONS Please name any awarding institute or professional body in full and include attainment level specifying relevant grades or grade of membership. 5 PERSONAL DEVELOPMENT 6 OTHER SKILLS Languages spoken/written (please indicate degree of competence). Computer literacy (please specify software and level of competence). Do you have armed service/public duty commitments? Yes No (eg are you a member of the TA/ a JP/ a Councillor, etc) If yes please give details: 7 OTHER INFORMATION How did you learn about this vacancy? Have you made an application to the GOC before? Yes No If yes, please give details: Are you currently eligible for employment in the UK? Yes No Please state what documentation you can provide to demonstrate this, eg British passport/European Economic Area identity card/ full birth certificate/ passport or travel document showing an authorisation to reside and work in the UK. Have you ever been convicted of a criminal offence? Yes No If yes, please give details (declarations are subject to the provision of the Rehabilitation of Offenders Act 1974 as amended.) What is your salary expectation? Page 2 of 3 APPLICATION FORM Please give details of current notice period? 8 HEALTH Applications from disabled candidates are welcomed and the organisation will make every effort to ensure a fair selection process. Are you in good health? Yes No Please give details of any health/disability problem(s) which may be relevant to the position applied for. Please describe below any reasonable adjustment which you feel should be made to the job itself which would enable you to carry out the job duties. 9 ADDITIONAL PERSONAL DETAILS Applicants are requested to tick the relevant boxes below to enable the organisation to monitor its equal opportunity policy. Monitoring is recommended by the Codes of Practice for elimination of racial discrimination and for the elimination of discrimination on the grounds of sex and marital status. This information is used for no other purpose and will be treated as confidential. White – British Mixed – Other White – Irish Asian/Asian British – Indian White – Other Asian/Asian British – Pakistani Black/Black British – Caribbean Asian/Asian British – Bangladeshi Black/Black British – African Other Asian Background Black/Black British – Other Chinese Mixed – White and Black Caribbean Other Mixed – White and Black African Male Female National Insurance number DECLARATION I declare to the best of my knowledge and beliefs, all particulars I have given in all parts of this applications form are complete and true. I understand that any false declaration or misleading statement or a significant omission may disqualify me from employment and render me liable to dismissal. I understand that any job offer is subject to references, checks on relevant qualifications, employment eligibility and criminal convictions, a probationary period and a medical report, all of which must be deemed by the GOC to be satisfactory. Signed: Date: Once you have completed application form please: Email to: firstname.lastname@example.org OR Post to: MS MANDY BAINGER GENERAL OPTICAL COUNCIL 41 HARLEY STREET LONDON W1G 8DJ (Please continue on separate sheet if necessary, giving page number and title heading) Page 3 of 3
"UNIQUE IDENTIFICATION NUMBER"