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UNIQUE IDENTIFICATION NUMBER

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					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?




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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: mbainger@optical.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)




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Description: UNIQUE IDENTIFICATION NUMBER