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1 EMPLOYMENT APPLICATION FORM Please complete this form in black ink or type, as it will be photocopied. The decision to shortlist for interview will be based solely on the information provided in this application. Additional information should be limited to one sheet of A4. Position applied for:... Personal details Surname... Title for correspondence (eg Mr/Mrs/Ms/Dr) Permanent address: Forenames... National Insurance number Post code:... Telephone no (Home):... (Work):... (Mobile):... address:... Please indicate preferred method of contact... Nationality at Birth:... Present Nationality (if different): Have you got a current driving licence? Yes No Where did you see this vacancy advertised?.. Do you require a visa to work in the UK? Yes No If yes, please state which visa or work permit you hold and expiry date Employment history 1

2 Beginning with your current or most recent employer and working backwards in chronological order, please give details of your career to date. Continue on a separate sheet if necessary with a brief summary of previous employers and roles held. Please put your full name on any additional sheets. Employer's name and address and type of business. Current: From Previous: From/To / State position held, salary payable & benefits and briefly outline your main responsibilities. Position Held: Reason for wishing to leave:... Salary:... Position Held: Reason for wishing to leave:... Salary:... 2

3 Previous: From/To / Position Held: Reason for wishing to leave:... Salary:... Periods not accounted for (Please give details of what you were doing during gaps in employment of more than two weeks (but not holidays) e.g. registered unemployed etc) Education history (Please give details of all education where applicable to essential criteria) Secondary school attended Examinations passed Grade 3

4 College/University attended Examinations passed Grade Training courses attended Membership of professional bodies Name of body, level and date of membership obtained (State whether by examination) Computing skills (Please list the software packages which you are familiar with and indicate your level of competence)


6 Supporting statement Please give your reasons for applying for this post. You should outline your interest in the post and describe your relevant skills and experience. You should also use this space to tell us anything not covered elsewhere, which you feel is relevant. Please check the job description and person specification before completing this section. You may use up to two sides of A4, include any relevant experience, knowledge or skills; this includes voluntary or unpaid work. Please do not attach your CV. 6

7 Availability and interview arrangements Please state your notice period or if unemployed when could you take up employment if appointed? Disabled Applicants If invited to interview, are there any special arrangements that you require?... You must sign and date this form Note: If you are successful at interview we will require proof of your eligibility to work in the UK. I declare that the information I have given is, to the best of my belief, true and complete. I give my consent for you to process and verify the information subject to the provisions of the 1998 Data Protection Act. If you give any information which you know is false, or you withhold any relevant information, this may lead to your application being rejected or, if you have already been appointed, to your dismissal. Signature... Date 7

8 References Please complete this section with the name, address and telephone number of your previous employers in the last three years. None of these should be a relative and one should be your current, or if you are unemployed, last employer. Reference: 1 (Current Employer) Name and address Telephone number and address May we contact your referees before interview? Please indicate with a in the relevant box. Period of service YES NO Reference: 2 Name and address Telephone number and address Period of service YES NO I consent to my referees being contacted as indicated above before or after interview. Name:... Signature:... Date:... 8

9 Equal opportunities monitoring form This form is separated from the main application form and will not be provided to the short-listing panel. Your answers will be treated in the strictest confidence. The information you provide will only be used for monitoring purposes and to assist us with improving our recruitment process to ensure we are reaching all sections of the community. How you complete this form has no connection to the evaluation of your application in any way. Position Title Sex: o Male o Female ABOUT YOU Gender Identity: Is your gender identity the same as the gender o Yes you were born with? o No ABOUT YOU (a) White (b) Mixed/Multiple Ethnic Groups (c) Asian (d) Black What is your ethnic group? Please choose one selection from (a) to (e) and then tick the appropriate box to indicate your cultural background. o British o Irish o Other. Please specify: o White and Black Caribbean o White and Black African o White and Asian o Other. Please specify: o British o Indian o Pakistani o Bangladeshi o Other. Please specify: o British o Caribbean o African o Other. Please specify: 9

10 (e) Chinese or Other o Chinese o Other. Please specify: The Equality Act 2010 defines disability as a physical or mental impairment, which has a substantial and long term adverse effect on an individual s ability to carry out normal day-to-day activities. You automatically meet the disability definition under the Equality Act 2010 from the day you re diagnosed with HIV, Cancer and Multiple Sclerosis. ABOUT YOU Do you consider yourself disabled? Yes o No o ABOUT YOU Please select your age group o o o o o 60 and over o ABOUT YOU How would you describe your sexual orientation? Please tick one box only. Heterosexual/straight o Gay Man o Gay Woman/Lesbian o Bisexual o Other o Prefer not to say o ABOUT YOU What is your faith / religion / belief? Please tick one box only. Atheist o Jewish o Buddhist o Muslim o Christian o Sikh o Hindu o Other. Please specify Prefer not to say o How did you find out about this vacancy? (Please give the name of the newspaper/journal/website). Please return your completed form via to or via post to: HR department, Queens Park Rangers Football Club, Loftus Road Stadium, South Africa Road, London, W12 7PJ 10