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Application Form
Job Title
Nationality Eligibility
Are you a citizen of the United Kingdom, a British Protected Person, a
Commonwealth citizen or a citizen of the EEA (European Economic Area)?
Yes No
Only citizens of the United Kingdom, British Protected Persons, Commonwealth citizens or citizens of
the EEA (European Economic Area) are eligible to apply.
Disability Declaration
I have a disability and would like to be given an interview under your
commitment to the Disability Confident Scheme.
Yes No
Do you require any assistance or special equipment if invited to attend an
interview?
Yes No
If ‘Yes’, please give details:
Equal Opportunities
We are an equal opportunities employer; we are committed to promoting equality and diversity
through our employment policies and practices. We believe that everyone should have the same
opportunities for employment and promotion, based on their abilities, qualifications and suitability for
the job. No applicant will receive less favourable treatment because of their race, age, sex, sexual
orientation, gender reassignment, marital status, disability, religion or belief, pregnancy or caring
responsibilities. Nor should anybody be disadvantaged because of conditions or requirements which
cannot be shown to be justified.
As users of the Disability Confident Scheme, we will interview all disabled applicants who meet the
minimum criteria for the post.
Data Protection
The information you give on this form is covered by the Data Protection Act 1998 and will only be used
for recruitment purposes. If you are appointed, this information will form part of your permanent
employment record. If you are not appointed, we will keep your information securely for 12 months
after which it will be destroyed.
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Please type or complete this form in black ink
1. Personal Details
Mr Mrs Miss Ms Dr Other
Title (tick the correct box): Please State:
Surname:
First names (in full):
Address and postcode:
Daytime telephone number:
Evening telephone number:
E-mail address:
National Insurance Number:
2. Birth and Nationality
Present nationality:
Nationality at birth:
Have you ever been a citizen of any country other than the UK?
If ‘Yes’, please give details:
Are you a legal resident in the United Kingdom?
Are you under immigration control?
If ‘Yes’, please give details:
Are there any restrictions on you continuing to live in the UK?
If ‘Yes’, please give details:
If you are appointed, documentary evidence will be sought to confirm your answers.
3. Education and Qualifications
Please give details of all qualifications relevant to the role (most recent first) with levels and grades
obtained, including class and division for degree courses (if applicable).
Qualification and Grade
School, College, University
Dates From/To
If you are appointed, documentary evidence will be sought to confirm your answers.
4. Relevant Learning and Development
Please provide information on the learning and development you have undertaken (most recent first)
that is relevant to this application, including membership of professional organisations. Please use a
continuation sheet if necessary.
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5. Present or Most Recent Employment
Employer:
Address:
Position held:
Date appointed:
Date left (if appropriate):
Salary and benefits:
Reason for leaving or wanting
to leave:
Period of notice required:
Brief description of main duties and responsibilities:
Are you currently employed by the Civil Service?
Yes No
If ‘No’, have you previously been a Civil Servant?
Yes No
Have you ever been a member of the Principal Civil Service Pension
Scheme (PCSPS)?
Yes No
6. Previous Employment
Please list all previous employment (most recent first) including any unpaid or voluntary work, and give
reasons for any gaps in employment.
Employer
Position and Responsibilities
Dates From/To
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Have any of the above resulted in the termination of your employment by
your employer?
Yes No
If ‘Yes, please give reasons:
7. Language Skills
Please tell us about your level of ability in Welsh:
Reading/Understanding:
Full understanding
Most material
Routine material
Simple material
Basic words/phrases
None
Listening/Speaking:
Fluent/confident
In most situations
With some hesitancy
Answer simple queries
Basic greetings
None
Writing:
Proficient
Prepare written work
Draft routine text
Answer simple queries
Write basic messages
None
Please tell us about your level of ability in English:
Reading/Understanding:
Full understanding
Most material
Routine material
Simple material
Basic words/phrases
None
Listening/Speaking:
Fluent/confident
In most situations
With some hesitancy
Answer simple queries
Basic greetings
None
Writing:
Proficient
Prepare written work
Draft routine text
Answer simple queries
Write basic messages
None
What is your preferred language for interview?
Welsh English
Your interview will be in your preferred language. If you have chosen Welsh as your preferred
language, on some occasions we may have to provide simultaneous translation from Welsh into
English. However, whatever your preference, your abilities in Welsh and English may be tested
depending on the specific language requirements for the post.
8. Core Skills and Job Specific Criteria
Please outline below how you match the key skills and job-specific criteria as outlined in the job
description. You should provide specific examples of experience and achievements that provide as
much detail as possible so that the panel can take an accurate view of your competence in these areas.
Please provide your evidence in the order listed in the Person Specification, starting with the
essential criteria. Follow this with evidence for the desirable criteria where applicable. As a general
guide we would expect no more than 200-300 words per criterion. Please use a continuation sheet if
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necessary.
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9. References
Please give the names of two referees, one of whom must be your current or most recent employer. If
you have just left school or college and have no previous work experience, please make sure that at
least one of your referees is one of your teachers or lecturers, or your head teacher or personal tutor.
Reference 1
Name:
Job title:
Address:
E-mail address:
Contact number:
Relationship to
applicant:
Reference 2
Name:
Job title:
Address:
E-mail address:
Contact number:
Relationship to
applicant:
Please make sure that the contact information you have supplied for your referees is up to date.
10. Declaration
The information I have given in this application is true and accurate to the best of my knowledge.
Signature:
Date:
For email submissions please tick the box to confirm the above
statement.
Confirm
To help us monitor our advertising policy please indicate where you originally learnt of this vacancy
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Please return this application via email to sue.billingsley@rcahmw.gov.uk or send a hard copy to:
The Human Resources Manager
RCAHMW
Ffordd Penglais
Aberystwyth
Ceredigion
SY23 3BU
You must be able to:
Satisfy basic eligibility criteria/certain conditions of employment and
Provide appropriate documentation to verify your ID, nationality, employment,
academic history and criminal record (unspent convictions only).
Supplying false information or failing to disclose relevant information could be grounds for refusal
and could amount to a criminal offence. If you are appointed using information that is
subsequently found to be incomplete or false, then you could face disciplinary action resulting in
dismissal.
Please do not send a CV. We only consider completed application forms.
Canvassing is prohibited.
Vacancies close at 17.00 on the closing date. No applications will be accepted after this time.
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