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iRecruitment Application Form


Job Title Dept/Div

Job Reference No Applicant No (for office use only)

Personal Details Full Name and Title Address Telephone Day

!venin" #obile !mail

Postcode Do you re$uire permission to %or& in the '() *!+ N,

Internal Only Vacancies Please note that only current -mperial .olle"e employees and A"ency /or&ers %ill be considered for internal only vacancies0 .asual /or&ers1 +tudents and applicants not currently employed at -mperial .olle"e %ill not be considered until the vacancy is advertised e2ternally0 Are you a current -mperial .olle"e employee) *!+ Please provide your .-D number Are you currently en"a"ed as an A"ency /or&er at -mperial .olle"e) *!+ Please provide Dates of en"a"ement From To Name of -mperial .olle"e mana"er/supervisor Department/Division en"a"ed %ithin If you carry out work within more than one department/division, please provide details for the position with the furthest extending end date. Fair Recruitment To ensure a fair recruitment process1 do you &no%1 or are you related to1 any employee of the .olle"e or member of an -mperial .olle"e committee) *!+ N, Please specify

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Applicants Referees Please "ive belo% the names and addresses of t%o from %hom references may be sou"ht1 at least one of %hom should have recent &no%led"e of your %or&3 your current employer should normally be included0 Please note that your current/most recent employer may be as&ed to verify your current/most recent annual salary0 -f it is their policy not to do so1 you may be as&ed to provide evidence of this yourself0 -t is .olle"e policy that references must cover the last three years1 therefore please ensure the referees you supply belo% are able to cover this period or include additional referees on a separate sheet of paper0 Name Address

Position #ay %e approach this referee before intervie%) *!+ N,

Telephone Fa2 !mail Address


Position #ay %e approach this referee before intervie%) *!+ N, "ec#s

Telephone Fa2 !mail

riminal Recor!s

Do you have any convictions1 cautions1 reprimands or final %arnin"s that are not $protected$, as defined %y the &eha%ilitation of 'ffenders Act "()* +,xceptions- 'rder "(). +as amended in !"#- %y SI !"# ""(/ and listed at %%%0imperial0ac0u&/hr/procedures/recruitment/criminalrecords/pnc 0 *!+ N,

Do you have any prosecutions pendin" a"ainst you) -f 4*!+5 please provide details separately in a sealed envelope0 *!+ N, .ertain posts are e2empt from the Rehabilitation of ,ffenders Act 67890 This %ill be indicated in the person specification0 Applicants for such posts are re$uired to declare any of the above mentioned convictions1 cautions1 reprimands or %arnin"s0 -f this applies to you1 please provide details separately in a sealed envelope0 This information %ill only be retrieved for the successful candidate0 -nformation provided by other applicants %ill be destroyed in a confidential manner0 +uccessful candidates for such positions %ill re$uire a Disclosure and :arrin" +ervice chec&0 $uarantee! Inter%ie& Sc"eme As part of its commitment to the T%o Tic&s scheme1 the .olle"e operates a ;uaranteed -ntervie% +cheme for disabled applicants %ho meet the essential criteria as detailed in the Job Description/Person +pecification0 -f you feel that you have a disability as defined by the !$uality Act1 you can choose to tic& the bo2 belo% Providin" that you meet all the essential criteria for the <ob1 you %ill be invited for intervie%0 Data Protection Act '(() *our si"nature on this document "ives the .olle"e the ri"ht1 under the Data Protection Act 677=1 to process the information that you have "iven1 includin" data of a sensitive nature1 for processes relatin" to your application %hich have been notified to the ,ffices of the -nformation .ommissioner0 Any processin" of the data %ill be in accordance %ith the .olle"e5s Data Protection Policy and the processin" principles set out in the Act0 Application forms of those %ho are unsuccessful %ill be destroyed after si2 months0 Asylum * Immi+ration Act '((,
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The Asylum and -mmi"ration Act 677> ma&es it a criminal offence for employers to employ someone %ho is not entitled to %or& in the '(0 /e1 therefore1 as& prospective employees to produce relevant documentation0 +hort?listed applicants %ill receive further details and successful applicants must provide relevant documentation before employment can be"in0 urrent Employment From (date) Name and Address of !mployer

Post Duties @ please also state Reason for Aeavin"


Notice Re$uired

Pre%ious Posts (most recent first)0 Please account for any "aps %here you have not been in employment From To !mployer Post Duties and Reason for Aeavin"

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Furt"er an! -i+"er E!ucation From To 'niversity/.olle"e +ub<ects Results

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Secon!ary E!ucation From To +chool !2aminations Results

Mem.er of Tec"nical or Professional /o!ies or ot"er 0ualifications

Statement in Support of Application +continue on separate sheets if re1uired-. Please state %hy you believe you are a suitable candidate for this post by e2plainin" ho% you meet its re$uirements and the e2perience %hich you have that is relevant0 Please "ive e2amples of particular achievements.

- confirm that the information and details provided on this form1 and other information relatin" to my formal application for employment1 are correct0 - understand that any false information or misrepresentation %ould result in my application bein" dis$ualified or1 if appointed1 could lead to my dismissal %ithout notice0 - a"ree that my application and associated information may be provided to those - nominate as referees1 and to those referees %ho are nominated by the Faculty/:usiness +chool0 - also a"ree that it may be necessary to disclose personal and sensitive data bet%een relevant or"anisations durin" the recruitment and selection process1 and durin" my employment1 e0"0 %ith local NB+ Trusts1 only %here it is necessary to do so1 and %here such disclosure does not contravene le"islation1 includin" provisions of the !$ualities Act0 Name of Applicant Date

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