Please give the names and addresses of two people willing to support your application, one of whom
should be your present or last employer. If you have been out of paid employment for some time, or
this would be your first job, you may give people who know you well as referees, one of whom could be
someone who has taught you. Referees are not usually contacted until
a preliminary job offer has been
made, and will not be contacted without your consent.
Name of Organisation and address
How do you know this referee?
Name of Organisation and address
How do you know this referee?
Please note that we will contact your referees at offer stage.
Data protection statement
The information in this Application Form will be held securely both manually and on the RCM’s
computerised HR database and will only be divulged to necessary staff members for the purpose of
the recruitment and selection process. Information on the successful candidate will be held for up
to 10 years following employment. Information on unsuccessful candidates will be held for up to 6
months. We reserve the right to verify the information you have provided and seek information from
other sources. The above rules have been assessed in line with the General Data Protection
Regulations 2018. You can find the RCM’s privacy policy relating to your rights regarding how we
handle your data here: https://www.rcm.org.uk/rcm-privacy-policy
. The information on the Equal
Opportunities Monitoring Form will only be used for monitoring our equal opportunities policy. Any
information required for statistical analysis will be used anonymously.
I declare that all the information given in this application is, to the best of my knowledge, complete
and correct.
I understand that if I am employed and any of the information I have provided is false, my Contract
may be terminated.
Signature Date
4