Disability Rights UK

Unification of Disability Alliance, National Centre for Independent Living and RADAR.
For office use only: Candidate reference number:

Private and Confidential

Introduction
Please ensure that you read the job description and person specification for this post and that you use the application form to show how you meet the essential criteria of the person specification. Only information provided on this application form will be considered by the Panel. Please do not submit a CV. All information given will be treated with the strictest confidence. Please complete this form and return it by 12pm on Wednesday 16 May 2012 to mary.convill@disabilityrightsuk.org or Mary Convill Resources Manager Disability Rights UK 12 City Forum 250 City Road London EC1V 8AF

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Application Section 1
Position you are applying for: State if applying part-time (job share) or full-time: Personal Details
Last Name: Other Names: Email address: Address (including postcode): Telephone number (Home): Telephone number (Mobile) Telephone number (Work):

Accessibility
Tell us below how we can assist you with further information about the post and any adjustments or arrangements you would like us to consider. Information Please specify your preferred format. Large Print Braille Audio Electronic (by email) Other, please state

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Reasonable Adjustments or arrangements at interview Do you need any reasonable adjustments or arrangements to be made at interviews? Yes No

If yes, please specify:

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Application Section 2
For office use only: Candidate reference number:

Private and Confidential

Education
From To School/College/Professional Institute Examinations taken and Qualifications Gained (Specify Grades or Degree Class Obtained)

Membership of professional organisations

Date joined Institute/ Organisation Grade Of Membership and Membership number (Where appropriate)

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Employment Record (Please list chronologically, starting with

current or last employer) Name and From: Job Title: Address of Job Function/ Employer / Nature of To: Responsibilities: Business: Final Salary and Reason for Leaving

Other training, development and relevant experience

Please give details of any other courses, memberships, voluntary work or responsibilities and awards achieved, including dates if appropriate, that you consider relevant to your application:

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Your suitability for this position

This is your opportunity to tell us about yourself, and how you fit the requirements of the job. Please say why you are interested in this post and provide specific examples of how you meet the criteria for this post. Do think about the skills and experience you have gained outside work as well as from work. You may wish to use the headings in the Person Specification in order to set the information out clearly. Please use as much space as you need.

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Declaration
I declare that the information I have given in this application and other relevant documents is accurate and true. I understand that providing misleading or false information will disqualify me from appointment or, if appointed, may result in my dismissal.

Signature (electronic signature or full name): Date:

Returning your application form

Please return this form by email to mary.convill@disabilityrightsuk.org

End of Form

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