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Confidential ApplicationFormand EqualOpportunitiesMonitoringForm Please complete clearly in black pen or typescript for copying purpose.

Please ensure all sections on the form are completed. Applicants should submit, together with the completed Application Form and Equal Opportunities Monitoring Form a: Curriculum Vitae Letter of Intent Positionappliedfor: PositionReferenceNo. Wheredid you learnof this vacancy? 1. PersonalDetails Surname: First name: AddressLine1: AddressLine2: AddressLine3: AddressLine4: Postcode: Tel: (home) Tel: (work) Country: Email: (home) Email: (work) Title: Middlename(s):

Whenare you availableto commenceemployment? Whatnoticeare yourequiredto give? 2. Nationality Nationality(E.g. British) Do youhaveany restrictionson Employmentin the UK? (E.g. Limitson stayin the UK, workinghoursrestrictions,workpermitrequirements) (Place an X in the applicable box) If YES, pleaseprovidedetails: YES NO

Do yourequirea workpermit? (Place an X in the applicable box) 3. Health Do yourequireany aids or adaptationsto attendinterview? (Place an X in the applicable box)

YES

NO

YES

NO

St Marys University College

Application with EO

Private and Confidential

If YESpleaseprovidedetailson the relevantsectionson the EqualOpportunitiesForm 4. EducationandProfessionalQualification(Mostrecentfirst) Secondary,Further & Higher Education From (MM/YY) To (MM/YY) QualificationsGained(includinggradesif applicable)

Please continue on a separate sheet if necessary, and attach to this application form.

5. Current/mostrecentemployment Nameof current/mostrecentemployer:

Dateappointed: Dateof termination: (if applicable)

Job Title: CurrentSalary: NoticeRequired: Reasonfor leaving:

St Marys University College

Application with EO

Private and Confidential

Brief outlineof yourdutiesandresponsibilities:

St Marys University College

Application with EO

Private and Confidential

6. PreviousEmployment Start with yourmostrecentemployerand detail any gapsin youremploymenthistory From To Employer Job Title & MainDuties Reasonfor leaving (MM/YY) (MM/YY)

Please continue on a separate sheet if necessary, and attach to this application form.

7. SupportingStatement Please tell us why you have decided to apply for this role and in what way you feel that you match the person specification.

Please continue on a separate sheet if necessary, and attach to this application form.

St Marys University College

Application with EO

Private and Confidential

8. CriminalRecord Do you have any unspent or pending criminal convictions? (Place an X in the applicable box)

YES

NO

If you have answered YES please provide full details in a separate sealed envelope addressed to the HR Manager - Operations, at the address shown below marked StrictlyPrivateand Confidential. 9. Referees Please give the names of people who could provide a reference regarding your suitability for the post for which you are applying, two professional including your current line manager (or most recent employer if you are not currently in employment). If this is your first post you should provide details of your head teacher or academic tutor; and one other appropriate professional. Relatives or partners must not be given as referees. Referees will be contacted at the shortlisting stage prior to interview unless you specifically request that they should not be contacted until an offer of employment is made. Placean X in the box if you do not wantyourrefereescontactedprior to interview Reference1. Name& Relationship:
(LineManageror mostrecentemployer)

CompanyName: Address: Email address: Reference2. Name& Relationship: CompanyName: Address: Email address: 10. Declaration I declare that the information contained in this application and in my CV is correct to the best of my knowledge and I understand that a false statement or omission may invalidate an offer of employment, or lead to the termination of my contract. I agree to the University College contacting my referees and agree that this will be done prior to being invited to interview unless I have specifically requested that they should not be contacted until an offer of employment has been made. (Please note all offers of employment are made subject to the receipt of satisfactory written references). I also agree to St Marys University College processing personal data contained in this form or other data which the University College may obtain from me or other people, in connection with my application. Signed: Date: Postcode: Postcode:

Please note that if you are sending this application form by email you will be required to sign the form if you are offered the position.
Human Resources Department St Marys University College Waldegrave Road, Strawberry Hill, Twickenham TW1 4SX Switchboard: 020 8240 4000 Fax: 020 8240 4257 Email: hrjobs@smuc.ac.uk

St Marys University College

Application with EO

Private and Confidential

This EqualOpportunitiesformto be detachedby HumanResourcesprior to shortlisting

EqualOpportunitiesMonitoringForm
Policy St Mary's University College believes that there should be no discrimination because of age, disability gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation. The University College will take appropriate steps to ensure that all employees are recruited, trained and promoted on the basis of ability, the requirements of the job, and where relevant, the need to maintain a highly effective student service. Monitoring To ensure that the equal opportunities policy is effective and to meet our legislative obligations detailed monitoring of applications will be carried out. This necessitates the collection of information regarding the applicants ethnic origin, sex, marital status, disability, religion, belief, and sexual orientation. This monitoring form is detached prior to shortlisting and is not seen by staff outside the Human Resources Department. All informationwill be treatedas strictlyconfidentialandin accordancewith the DataProtectionAct 1998. Genderand Dateof birth Female Male

Date of Birth (DD/MM/YYYY) Marital Status Civil Partnership Co-habiting

Other (Please specify) Widowed

Divorced Married

Single Separated

EthnicOrigin The following categories have been devised by the UK governments Census of population and are recommended by the Commission for Racial Equality. It is important to understand that these questions are not about nationality, place of birth or citizenship. Asian or Asian British - Bangladeshi Asian or Asian British - Indian Asian or Asian British - Pakistani Black or Black British - African Black or Black British - Caribbean Chinese Mixed - White and Asian Mixed - White and Black African Mixed - White and Black Caribbean My Nationality is: Other Asian background Other Black background Other Ethnic background Other Mixed background Other White background White British White Irish Prefer not to answer

PTO
St Marys University College Application with EO Private and Confidential 6

Sexualorientation Heterosexual Prefer not to answer Religionor belief My Religion or Belief is: Prefer not to answer Disability A disability or health problem does not preclude full consideration for a job. Applications from people with disabilities are treated in the same way as others. The following details are strictly confidential for the Human Resources Department information only. Do you have a disability? No Yes - please select from the option(s) below Specific learning disability (such as dyslexia or dyspraxia) General learning disability (such as Cerebral Palsy or Downs Syndrome) Cognitive impairment (such as autistic spectrum disorder or resulting from head injury) Long-standing illness or health condition (such as cancer, diabetes, arthritis, chronic heart disease, or epilepsy) Mental health condition (such as depression, anxiety or bipolar) Physical impairment or mobility issues (such as difficulty using arms or using a wheelchair or crutches) Deaf or serious hearing impairment Blind or serious visual impairment Other type of disability Prefer not to answer There are 8 categories in the relevant legislation which are used to assess whether an individuals condition is likely to be deemed a disability and applicants may wish to declare any conditions. Please describe any special needs in the box below so that any arrangements and reasonable adjustments necessary for an interview can be made Bisexual Gay Lesbian

Thankyou this EqualOpportunitiesformis nowcomplete

St Marys University College

Application with EO

Private and Confidential