APPLICATION FORM

Please complete all fields marked with ‘ * '. You will not be able to send the application form if any of the required fields are not filled.

**If you are filling this application form ONLINE, after completing the relevant blue boxes, please
press the “Send” button (at your right hand side) to apply for this vacancy.
Send
**Please note that once you have DOWNLOADED and SAVED this application to your
computer for completion later, you will need to print it out and send it by POST to the employer.
The “Send” button is designed for sending UNSAVED electronic forms ONLINE ONLY.

Responses to the questions can be written in a word processing package and cut and pasted
across into the live form. When pasting please note that occasionally formatting can change and
will need to be amended within the form.
 Application Form

Please read the following before filling in the form

All the information in this application form will be treated in the strictest confidence. In the interest of
economy, we do not normally acknowledge receipt of your application form unless received via e-mail. If
you have not had an invitation to interview from us within six weeks of the closing date, you may
assume you have been unsuccessful. Please complete this form neatly and accurately in black ink or
type. If hand written, please make sure your writing is legible.

Applications submitted in CV format alone will not be accepted.

Instructions:
This form can be completed and submitted in a variety of ways:
• This application form may be printed, completed by hand and posted to the address at the end
of the form.
• This application form can be filled in by saving as a word document to your hard disk and then
completed electronically. The completed form can then be printed and posted as above, or e-
mailed directly to the Personnel department by following the instructions below:

Instructions for electronic application

• Save this application form as a word document to your hard disk.
• Close the web page and open the saved application form from your hard disk.
• Complete each field of the application form by typing your response in the appropriate space. If
additional space is required attach a new page to the end of the document rather than
expanding the boxes. Once completed, save the document again and attach the form as an e-
mail attachment and send to: plc.hr@parklanecoll.ac.uk
• You should save a copy to your Hard Disk or print out for reference.

Due to our requirement to receive all applications in a standardised format, we cannot accept any
applications that are not submitted in accordance with the instruction given above.

Printing your name and e-mailing the form is equivalent to signing the declaration section
and certifies that all particulars are correct.
 Application Form

Post Applied For:

Vacancy Reference: Closing Date:

Personal Details:
* *
Surname Forename(s)

Title Mr / Mrs / Miss / Ms / Dr / Other __________

*
Tel no (day)
* Address
Tel no (eve)

e-mail
*

DfEE Ref no.

(academic posts)
Post National Insurance
code Number

Sickness Absence
(Please indicate total sickness absence details over the past 2 years.)
Reason Number of days absent

Education:
Please list in chronological order ending with your most recent achievement

Name of school, college, university, institute etc From To Qualifications obtained/ Grade
level of membership
Training
Subject / Title Organising Body Date Completed Duration

Current Employment (or appropriate details if Self Employed)

Position held:

Name and address of employer:

Salary: Grade:

Date of commencement: Notice required:

Previous Employment (starting with most recent)

Name and address Job Title From To Reason for leaving
of employer

Other Work Experience and Professional Roles (list here any other work experience e.g. temporary,
voluntary or domestic work, and other professional activities e.g. examinerships, memberships of professional
organisations).
Supporting Statement
You are asked to submit a statement in support of your application addressing issues you regard as relevant to the post
as described in the Job Details supplied. If further space is needed attach a page to the end.

General Information Place an ‘X’ in the appropriate box

Have you ever used any surname other than your current Yes No If yes, please give details:
surname?
Do you have the right to live and work in the UK? Yes No

Do you contribute to any pension scheme? Yes No If yes, please give details:

Are you currently receiving an occupational pension? Yes No If yes, please give details:

Are you related to any employee or Governor of the College? Yes No If 'Yes', state their name & position held

Where did you first see the post advertised?

(if internet please indicate the name of the website)

Do you possess a full, clean driving licence? Yes No

 Disclosure of Criminal Offences
Because of the nature of the work for which you are applying, this post is exempt from the provisions section 4 (2) of
the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders (Exemptions) Order 1975.
Applicants are not entitled to withhold information about convictions, which for other purposes are 'spent' under the
provisions of the Act, and in the event of employment any failure to disclose details could result in dismissal by the
College.
Any information given will be completely confidential and will be considered only in relation to the application for
positions to which the Order applies.
If none, please state ‘none’ below
Please give details:

Referees
Please nominate three referees who will be approached by the College should you be short listed for interview, one of
which must be your present or most recent employer. If you are in or have just completed full time education, one
referee should be from your school or college. References should be in relation to previous employment, we will accept
no more than one personal reference.
Please indicate if you do not wish references to be taken up before interview by placing an ‘X’ in ( ). Please note that
successful applicants cannot commence work until we have received a reference from your most recent
employer; in order to avoid delays we would ask that you only place an ‘X’ in the box if you strongly object to
our approaching your current or most recent employer.
Referee 1: ( ) Referee 2: ( ) Referee 3: ( )
Employer Employer Employer / Personal
(delete as appropriate) (delete as appropriate) (delete as appropriate)
Name: Name: Name:
Position: Position: Position:
Company: Company: Company:
Address: Address: Address:

e-mail: e-mail: e-mail:

Tel. No. Tel. No. Tel. No.

Data Protection:
Please note that the details you provide on this application form will be entered onto the College computer system and
will be held within a manual filing system. Information provided is subject to the Data Protection Act 1998 and may be
shared with selected third parties. Any information disclosed is to help produce Government statistics and will only
include name, date of birth, job title and start date.

In signing (including electronically) this form you are signifying your agreement to the processing and storage of these
details.

DECLARATION I hereby certify that the above particulars are correct. I understand that
deliberately giving false or incomplete information would disqualify me
from appointment, or in the event of discovery after appointment, make
me liable to dismissal.

Name (printed or signed): Date:

If you are offered employment with Park Lane College, the offer will be subject to verification of qualifications,
Criminal Records Bureau check, medical clearance and receipt of satisfactory references, as appropriate.

If you are e-mailing the form, by printing your name and e-mailing you will have certified that all information is
accurate.

e-mail a copy of the completed form to: plc.hr@parklanecoll.ac.uk or for a paper application, post to:
Personnel Department, Park Lane College Leeds, Park Lane, Leeds LS3 1AA
Equal Opportunities Monitoring
This form will be detached and retained within the Human Resources Department.

Name of applicant:
Sex:
Marital Status:
Nationality:
Date of Birth: Age:

Ethnic origin: (place an ‘X’ in the appropriate box)

Asian or Asian British Black or Black British
Bangladeshi African
Indian Caribbean
Pakistani Any other Black background

Any other Asian background

Chinese
Chinese

Mixed Race White

White and Black Caribbean British
White and Black African Irish
White and Asian Any other white background
Any other mixed race
background

The Disability Discrimination Act defines a disability as a condition, either physical or mental, which is
substantial and has a long-term effect. You no longer have to be registered disabled to be classed as
having a disability. All information provided is treated sensitively and with the strictest of confidence.

Do you consider yourself to have a disability? Yes No

If 'yes' please give brief details and specify any possible support that the College can provide at interview and
during employment:

Thank you for taking the time to complete this monitoring form and assisting Park Lane College in
fulfilling its Equal Opportunities Policy.