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INSTITUTE FOR ANIMAL HEALTH
APPLICATION FORM FOR EMPLOYMENT
1. Vacancy details
IAH Reference No IAH Site
Post Applied For
Initial & Surname
Where did you hear of this vacancy?
2. Present or most recent employment
Name & address of Dates Reason for leaving
employer From/To Salary Job title or wishing to leave
(include notice period if
applicable)
Key duties and responsibilities.
3. Previous Employment (Previous 3 years)
Previous Employers Dates
(please continue on separate sheet if necessary) Position & responsibilities Reason for leaving
From/To
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4. Periods unaccounted for
(e.g. unemployment, voluntary work, career breaks, travel)
Dates Details
5. Academic Record
(If you are currently studying, please provide details of the qualifications you are studying for).
Details of schools attended, examinations/qualifications taken or to Results and grades
be taken (include subjects)
Full details of qualification obtained
Name of University, College(s), Further Education (Including Classification, if relevant)
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6. Professional Record
Occupational training/job related courses (Name of Course & Content)
Membership of Professional Bodies
7. Experience in using Information Technology
Please give details of the software packages which you have been accustomed to using and any other
experience in using IT.
8. Relevant Skills, Knowledge and Experience
Please indicate why you are applying for this post and outline how your knowledge, skills and experiences
meet the competencies required for this role (as detailed in the job specification). You should draw on your
experiences from your current or previous roles or from other relevant situations (such as activities outside
of work). (please continue over if necessary).
Continued over
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8. Relevant Skills, Knowledge and Experience continued
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9. Personal Details (In confidence)
Forenames Surname & Title (Prof/Dr/Mr/Mrs/Miss/Ms/Other)
National Insurance Number
Present Address Previous Address (If you have lived at your present
address for less than 12months)
Post Code: Post Code:
Home: Mobile:
Other Contact Details Work: e-mail:
May we contact you at work? (please tick box that applies) Do you require a work permit? (please tick box that applies)
YES NO YES NO
10. References
Please give names and addresses of three referees (who should not be related to you) who may be
approached in connection with your application. The first must be your current or most recent employer.
Name:
Address:
e-mail Address: Telephone number:
May we request a reference prior to interview? (please tick box that applies) YES NO
Name:
Address:
e-mail Address: Telephone number:
May we request a reference prior to interview? (please tick box that applies) YES NO
Name:
Address:
e-mail Address: Telephone number:
May we request a reference prior to interview? (please tick box that applies) YES NO
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11. Nationality and Immigration Status
Nationality at Birth
Present Nationality (if different)
Have you ever possessed any other nationality or citizenship? YES NO
If YES please specify:
Are you subject to immigration control? YES NO
If YES please specify:
Are you lawfully resident in the UK? YES NO
Are there any restrictions on your continued residence in the YES NO
UK?
If YES please specify:
Are there any restrictions on your continued freedom to take YES NO
employment in the UK?
If YES please specify:
If applicable please state your Home Office / Port reference
number here:
12. 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 on this and the Equal opportunities
form 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. We may also use the information if there is a complaint or legal
challenge relevant to this recruitment process.
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 Commissioner.
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13. Criminal Conviction Declaration Form
The Institute for Animal Health respects the privacy of its candidates and the provisions of the Rehabilitation of
Offenders Act, 1974. However, it has a duty to protect its staff and others on its premises. Therefore please answer
the following questions. Your answers will remain confidential.
1, a. Have you ever been convicted or found guilty by a Court of any offence in any country (excluding
parking but including all motoring offences even where a spot fine has been administered by the police) or
have you ever been put on probation (probation orders are now called community rehabilitation orders) or
absolutely/conditionally discharged or bound over after being charged with any offence or is there any
action pending against you? You need not declare convictions which are now “spent” under the
Rehabilitation of Offenders Act (1974).
Yes No
1, b. If YES, please give details of the offence(s) you were convicted of, the date of the conviction(s) and
the sentence(s) passed:
2,a. Have you ever been convicted by a Court Martial or sentenced to detention or dismissal whilst serving
in the Armed Forces of the UK or any Commonwealth or foreign country? You need not declare convictions
which are “spent” under the Rehabilitation of Offenders Act (1974).
Yes No
2,b. If YES, please give details:
Important:
Data Protection Act (1998). This form asks you to supply “personal” data as defined by the Data Protection Act
1998. You will be supplying this data to the appropriate HR or Security authority where it may be processed
exclusively for the purpose of a check against the National Collection of Criminal Records. The HR or Security
authority will protect the information which you provide and will ensure that it is not passed to anyone who is not
authorised to see it.
Failure to disclose any unspent conviction or any criminal charges that are pending, and
that are directly relevant to the position sought, may lead to the withdrawal of an offer of
employment or termination of employment. Possession of a criminal record will not
necessarily preclude applicants from employment with IAH.
Signature: ………………………………………………………………………Date:
………………………
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14. Declaration
I declare that the information given on all parts of this application form, and in any other forms or documentation
which accompanies it, is, to the best of my knowledge, correct. I understand that giving false information will make
my application unacceptable and, if I am appointed, lead to my dismissal. I accept that:
• If I am appointed, the information of this form may be used, in accordance with Schedule 2 of the Data
Protection Act 1998, to form a part of my permanent personal record.
• The information in the Equal Opportunities Monitoring form which accompanies the application form, will be
used in accordance with Schedule 3 of the Data Protection Act 1998 to identify and review the equality of
treatment between individuals with a view to enabling such equality to be promoted and maintained. It will not
be seen by those who are responsible for making selection decisions.
• I understand that pre employment checks will be sought in the event of a successful application.
Signature: ………………………………………………………………………………. Date: ………………….
Please return Application form and Equal Opportunities Monitoring Form to:
HR Department
Institute for Animal Health
Compton Laboratory, Compton, Newbury, RG20 7NN
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