RDA NATIONAL SECRETARIAT APPLICATION FOR EMPLOYMENT AND DIVERSITY INFORMATION Complete the following information and return it with a copy of your Curriculum Vitae (CV), demonstrating how your knowledge, skills, experience and competencies match the job description. This information will be detached from your CV prior to shortlisting and will not be seen by those involved in the recruitment process. Applications (Application for Employment and Diversity Information plus your CV) should be emailed to HR@nwda.co.uk (preferred) or returned in an envelope marked “Confidential - Application for Employment� to Kate Allen, HR Co-ordinator, HR,OC&D, Northwest Regional Development Agency, Brew House, Wilderspool Park, Greenalls Avenue, Warrington WA4 6HL.
Personal Details Application for appointment of:
National Networks Manager
Job Reference:
Closing Date:
Surname
N/A
16/02/2007
Forenames
Preferred name Title
Date of Birth
Address:
Post Code: Home phone number Mobile phone number
Business phone number Business fax number
Data Protection The information provided on this Application Form is and will remain Strictly Private and Confidential. Your personal details will not be divulged to any other Company and/or Organisation other than to those connected with The RDA National Secretariat or Northwest Regional Development Agency (NWDA), or where there are circumstances whereby NWDA have a duty to do so. You have a right to see the personal information which is held about you upon written request to the HR, Organisational Change and Development Department.
Recruitment Advertising - Please indicate media in which you saw the advertisement:
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Equal Opportunities Policy and Diversity Recruitment Monitoring The NWDA endeavours to be an equal opportunities employer. In declaring a commitment to the promotion of equality of opportunity, the NWDA welcomes applications from all sections of the community irrespective of age, gender, marital status, sexual orientation, disability, race, colour, ethnic or racial origin and nationality. In order to assist us in equal opportunities, please complete this section by placing a ‘X’ in the appropriate box within each category. All responses will be treated in the strictest confidence, and solely used for statistical purposes. Source of application:
Internal
External
Gender:
Male
Female
Age:
16-20
21-30
31-40
41-50
51-60
61-65
Under the definition of the 1995 Disability Discrimination Act, do you consider yourself to be disabled? Yes
No
What is your ethnic Group? WHITE British
English Irish
Scottish Welsh Any other white background:
Other
MIXED White & Black Caribbean White & Black African Any other mixed background (please write in):
White & Asian
ASIAN, ASIAN BRITISH, ASIAN ENGLISH, ASIAN SCOTTISH, OR ASIAN WELSH Indian Pakistani Bangladeshi Any other Asian background (please write in): BLACK, BLACK BRITISH, BLACK ENGLISH, BLACK SCOTTISH, OR BLACK WELSH Caribbean African Any other black background (please write in): CHINESE, CHINESE BRITISH, CHINESE ENGLISH, CHINESE SCOTTISH, CHINESE WELSH, OR OTHER ETHNIC GROUP Chinese Any other background (please write in):
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Additional Information Driving licence Do you possess a Driving Licence: Types of vehicle permitted to drive
Yes
No
Referees Offers of employment are subject to the receipt of at least two acceptable references, one of which should be from your current or most recent employer. Please provide the following: Professional Referee: Name Occupation Address
Post Code
Phone Number
Email Address
At what stage may we contact this referee?
Personal Referee: Name Occupation Address
Post Code
Phone Number
Email Address
At what stage may we contact this referee?
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Special Needs The NWDA is committed to providing equal opportunities and will make reasonable adjustments to working arrangements to meet special needs. If you have any special needs it would be helpful for you to indicate them here to ensure that early adjustments can be made.
Relationships Are you related to any current RDA National Secretariat or Northwest Regional Development Agency Employee or Board members (If yes, please supply name and position)
Yes
No
Yes
No
NB – Canvassing will lead to disqualification
Rehabilitation of Offenders Have you ever been convicted of an offence by a court?
NB – If under the Rehabilitation of Offenders Act 1974, your past conviction is ‘spent’, tick NO, if YES, please give details:
Declaration - I confirm that the information provided in this application is correct and true. Signature Date
If we employ you and we subsequently discover that you have been deliberately dishonest or evasive in your reply to this question by failing to reveal unspent convictions, your dishonesty may later constitute grounds for dismissal. False information will lead to disqualification of appointment or dismissal.
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