Application For Employment
Please read all accompanying information before completing this application form
Please type or write clearly using black ink (as this form will be photocopied). Sign and return the form to:
E. Harris, Deputy Director, MUSU, Trent Park Campus, London, N14 4YZ
(Please put a cross ； or ; in the relevant circle)
Application for the post of: Office Coordinator Closing date: 18 Feb 11 Post Reference No: OFC2011 We do not accept applications “on spec”. Applications must be in response to a specific post advertised This field is important
？ Mrs ？ Ms ？ Miss ？ Dr ？ Prof. ？ Title: Mr A. Personal Details
Other ？ (please specify) Family name:
Name you wish to be ‘known as’ if not your forename
or if you prefer a shortened version of your name: National Insurance Number:
Postcode: Work Tel No: Ext.
May we contact you at work? YES ？ NO ？
Tel No: Home:
E-mail address: Mobile:
Do you require a work permit? YES ？ NO ？ (Please note that work permits are not transferable between employers)
Name and Address of current or most recent employer: Post held:
Please state notice period and/or earliest start date:
Tel No: Reason for wishing to leave or for leaving: E-mail address:
Please summarise the main duties and responsibilities in your current or most recent job:
C. Previous Employment
(Please give details of previous posts held and include any relevant voluntary or unpaid work - continue on a separate sheet if required)
Dates Past Employer(s) most recent first Post held and main role(s) Reason for Leaving
D. Additional Information in support of your Application
; Please give details of your relevant skills, experience, knowledge and achievements, demonstrating how you meet the requirements of this post, referring to the job description and the person specification;
D. Additional Information Continued
E. Education and Training
(If you have attended a place of further or higher education, information concerning schools and school examinations may be
omitted). You will be required to produce original certificates/qualifications.
a) Secondary education OR Further and/or Higher education, giving most recent qualification first
Level Grade Year obtained School/College/University/OtheQualification and subjects(s)
b) Qualification(s) currently being undertaken
Institution/Provider Qualification/level Subject(s) Exam/finish date
c) Relevant Training and Non-Qualification Courses Attended
d) Membership of Professional Body (ies)/Professional Qualification(s) (If more than one, please list all)
Name of Professional Body(ies) Qualification(s) Membership Registration Date level No. obtained
F. Disclosure of a Criminal Record/Rehabilitation of Offenders Act 1974 (to be completed by all applicants)
If the post you have applied for is exempt from the Rehabilitation of Offenders Act 1974 and requires a Standard or Enhanced Disclosure (as indicated on the job description), you must disclose all convictions (whether spent or unspent), cautions, reprimands and final warnings on your criminal record. (Please read the guidelines carefully)
If the post is subject to either a Standard or Enhanced Disclosure, you must answer the following question:
Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? YES ？ NO ？
If the post is subject to Enhanced Disclosure, you must also answer the following question:
Are you aware of any police enquiries undertaken following allegations made against you or do you have any pending
prosecutions, which may have a bearing on your suitability for this post? YES ？ NO ？
For all other posts: Do you have any unspent criminal convictions? YES ？ NO ？
(If you answer yes to any of the above questions, please give details of offences, penalties and dates on a separate sheet (which should be signed and dated), enclose in a sealed envelope marked ‘Private & Confidential’ and attach to the form. Write your
name, the post reference number and job title on the envelope.)
Have you worked for Middlesex University or Middlesex University Students’ Union before? YES ？ NO ？ If
yes, please state dates employed and job title:
Please indicate if you are applying for this post on a job share basis YES ？ NO ？
If yes, please state (a) number of hours you wish to work per week ____ (b) do you have a job share partner Yes ？ No ？
How many days sickness have you had in the last 12 months ___ and on how many occasions ___ ?
G. Disability (To be completed by all applicants)
The Disability Discrimination Act 1995 defines a disabled person as anyone who has or has had a physical or mental impairment which has a substantial and long-term effect on their ability to carry out normal day-to-day activities. Taking this definition into consideration, do you consider you have a disability? : YES ？ NO ？
If YES, please describe any equipment you may need or adaptations which you consider may need to be made to
accommodate your disability(ies) if you are appointed to this post.
If you are shortlisted, please describe any special arrangements which you would like the Students’ Union to make for
Please give names and addresses of THREE referees, not related to you, who are willing and able to provide up-to-
date information on your qualifications, experience and skills. One of these must be your line manager from your current or most recent employment or if you have not been employed, a referee related to relevant voluntary or
community work or, if appropriate, your head teacher or lecturer/tutor from your last school or college or university.
We reserve the right to contact your present/last employer if an offer is made and accepted. References may be
taken up prior to interview, unless you have specifically requested otherwise in the section below.
Name 1. 2. 3.
May we contact YES ？ NO ？ YES ？ NO ？ YES ？ NO ？ prior to interview?
; I understand the Students’ Union reserves the right to withdraw an offer of appointment or to terminate my employment with or
without notice or payment in lieu in cases where: (a) it is discovered I do not have the claimed qualification or experience (b) I
do not obtain, for whatever reasons, any appropriate examination or licence; (c) I become disbarred from the appropriate
Regulatory Body or Authority.
; I understand that an offer of appointment will be subject to references satisfactory to the Students’ Union. I understand that, if the post is subject to Standard or Enhanced Disclosure, I must disclose details of any criminal record, including convictions,
cautions, reprimands and final warnings and (for Enhanced Disclosure) any other information that may have a bearing on my
suitability for the post.
; I understand that providing false or misleading information will disqualify me from appointment or if appointed will render me
liable to dismissal without notice.
; I declare that the information I have given is, to the best of my knowledge, true and complete.
; I agree that the information given may be used for registered purposes under the Data Protection Act 1998.
Has anyone else completed this form on your behalf YES ？ NO ？
Rev: March 2006
Confidential POST REFERENCE NO:FPC1
Middlesex University Students’ Union
FOR MONITORING PURPOSES ONLY Nationality: Please refer to the ‘Guidelines for Applicants’
As part of MUSU’s Equal Opportunities
Policy, we aim to ensure that all applicants for posts As some of the recruitment process is decentralised, a
receive equal treatment irrespective of their age, gender, section on disability appears both in the main application ethnic origin or disability. In order to monitor the form so that managers are made aware of any
effectiveness of the policy and to assist in its reasonable adjustments required during the process and
development we should be grateful if you would complete in this tear-off part which is used by Human Resources to
this section. monitor equal opportunities.
The Disability Discrimination Act 1995 defines a disabled This section will be separated from your application
person as anyone who has or has had a physical or form when received and retained in Human
mental impairment which has a substantial and long-term Resources. effect on their ability to carry out normal day-to-day activities.
Application for the post of: Taking this definition into consideration, I would describe
myself as disabled: YES ？ NO ？
Surname: How did you become aware of this vacancy? Forenames: If it was through a newspaper/journal please state which one. Date of Birth: Age: Gender: Male ？ Female ？ Ethnic Origin
Your ethnic origin is not your nationality, place of birth or citizenship but refers to your colour and broad ethnic group.
I would describe my ethnic origin as:- (Please put a cross
I declare that all information given in this application is, to ； or ; in the relevant circle) the best of my knowledge, complete and correct.
White - British ？
White - Irish ？ White - Other ？ Black or Black British - Caribbean ？
Black or Black British - African ？
Black - Other ？ Signed: Asian or Asian British - Indian ？ Asian or Asian British - Pakistani ？ Asian or Asian British - Bangladeshi ？ Date:
Chinese ？ Asian - Other ？ Rev. March 2008 Mixed - White and Black Caribbean ？
Mixed - White and Black African ？
Mixed - White and Asian ？
Mixed - Other ？
Other Ethnic Background ？