What was your job title, what did you do and what do you think you were good at?

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1 POST TITLE: PERSONAL DETAILS Name: Address: Contact details Telephone Home: Telephone Work: Mobile: WORK EXPERIENCE Let us know about any jobs that you have had or any voluntary work that you have taken part in (this could be helping to run a school event, work experience etc.) Name and full address of place of work. What was your job title, what did you do and what do you think you were good at? Reason for leaving and date of leaving QUALIFICATIONS Please detail any school, higher or further education qualifications that you have (GCSE s, A- Levels, BTEC, Degree etc.) including the grade you achieved.

2 In this section, we want to find out more about you. Look at the job description and tell us how you feel you meet the person specification. Think about any relevant experience from school/ work/ volunteering or other activities which you feel will support your application. Please tell us why you would like this internship: How do you think you meet the person specification that we set out in the job description: (Please continue on a separate sheet if necessary, giving page number and title heading.)

3 Other information Please let us know of any other information that might be relevant to your application. References Please give us details of two people for references. These people should not be family members; one should be your most recent employer or teacher/ lecturer. Referees will not be contacted unless you are successful at interview. Referee One Name: Address: Referee Two Name: Address: Phone number: Relationship to you: Phone number: Relationship to you: I give/do not give permission to take up my reference prior to an offer of employment being made. (Please delete clearly as appropriate) Have you ever been convicted of a criminal offence? (declaration subject to the Rehabilitation of Offenders Act 1974) YES/NO If yes, please provide details

4 Are there any medical conditions that you suffer from that we should know about that would prevent you from doing something essential to the job? If yes, please can you outline the medical condition(s)? Do you consider yourself to be disabled under the Equality Act 2010? If you have a disability please tell us about any adjustments we may need to make to assist you at interview Right to work in the UK Right to work If you are selected for interview, please be prepared to bring with you, evidence of your right to work in the UK. This is required under the Immigration (Restrictions on Employment) order For more information please visit Please bring a passport and proof of address OR A Birth Certificate, Proof of NI number from HMRC and Proof of address

5 Data Protection The information provided on this application may be stored and processed by Portsmouth Cultural Trust for a period of six months for recruitment purposes and if successful the information will be stored on personal file and processed for the purpose of the employment relationship. Portsmouth Cultural Trust keeps personal information on all employees and provides such information only on a need to know basis. By accepting a job offer, employees agree to our retaining such information, which can include sickness and health records, ethnic origin, trade union membership and disciplinary matters. Once a year without charge employees can inspect their records and, if necessary, request correction of any faulty records Equal Opportunities Portsmouth Cultural Trust is an equal opportunities employer and is committed to ensuring that our recruitment process is open, fair and not influenced by irrelevant considerations. To that end an Equal Opportunities Recruitment Monitoring Form is attached. Declaration All claims and/or statements of skills, experience, qualifications and employment will be checked. In the event of false claims being made, any offer of, or employment will be terminated. Portsmouth Cultural Trust reserves the right to recover from an applicant/employee any costs incurred as the result of the employment of someone who has submitted an application form (or other evidence of experience) containing false claims To the best of my knowledge I declare that the information contained in this application form is accurate and correct. I understand and agree that: a) The provision of false information may result in disqualification from the recruitment process or termination of employment. b) Where I cannot provide evidence of qualifications, suitable references and/or the right to live and work in the United Kingdom the offer of employment may be rescinded and/or employment terminated. c) Under the Rehabilitation of Offenders Act (if it applies to the post for which I am applying) failure to disclose any convictions spent or otherwise will result in non appointment or disciplinary action and potential dismissal. d) Where the post for which I am applying requires a background check, I hereby agree to the relevant check being made by the relevant organisation about the existence and content of a criminal records spent or otherwise. e) The Trust does not acknowledge receipt of application forms. PLEASE SIGN AND DATE ON NEXT PAGE

6 Signed: Printed name: Date: Once you have completed all three parts of this application form please: to OR If you are selected for interview, you will be required to sign this form before the interview in order to confirm that all the information provided is correct. post : to Hayley Reay, Portsmouth Cultural Trust, Portsmouth Guildhall, Guildhall Square, Portsmouth, PO1 2AB


8 Equal opportunities monitoring form UNIQUE IDENTIFICATION NUMBER: (Please leave blank) This section of the application form will be detached and used solely for monitoring purposes. Portsmouth Cultural Trust recognises and actively promotes the benefits of a diverse workforce and is committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation, religion or belief. We therefore welcome applications from all sections of the community. Please tick the boxes which describe you most closely: Date of birth for monitoring purposes only Gender: Male Female Prefer not to say What is your ethnicity? Ethnic origin categories are not about nationality, place of birth or citizenship. They are about the group to which you as an individual perceive you belong. Please indicate your ethnic origin by ticking the appropriate box below. Arab Middle Eastern Arab North African 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 Japanese Latin American Mixed White and Asian Mixed White and Black African Mixed White and Caribbean Other Asian Background Other Black background Other Ethnic background Other Mixed background Other White background If any other category ticked, please specify if you wish: White - British White - Irish Prefer not to say

9 What is your sexual orientation? Bisexual Gay woman/lesbian Other Gay man Heterosexual/straight Prefer not to say What is your religion or belief? Buddhist Christian Hindu Jewish Muslim Sikh Other If any other category ticked, please specify if you wish: No religion Prefer not to say Disability Definition of Disability The Equality Act 2010 defines disability as A physical or mental impairment which has a substantial and long term adverse effect on a person s ability to carry out normal day to day activities. Long term in this context means likely to last longer than 12 months or likely to recur. Please note that cancer, HIV and multiple sclerosis are covered by the Act from the point of diagnosis. Do you have a disability as defined in the Equality Act 2010? Yes No Prefer not to say If yes, please state the nature of your disability or long term condition: