Please complete this form in black ink or typescript.Continue on the back of this form or a separate sheet if necessary.

Position applied for: Operations and Development Assistant

Personal Details

Surname (Block letters):

Forename(s):

Date of birth:

Telephone number:

Mobile number:

Address:

Email address:

Full Clean Driving Licence? Yes / No Do you have daily access to a car for business use? Yes / No

Where did you see this post advertised?

FOR OFFICE USE ONLY

INTERVIEW DATE TIME

CONFIRMED REFERENCES REQUESTED REFERENCE RECEIVED

APPOINTMENT OFFERED

STARTING SALARY START DATE

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Previous employment (most recent position first)

Employer & Post From: To: Salary:

Brief outline of duties

Reason for leaving Period of notice

Employer & Post From: To: Salary:

Brief outline of duties

Reason for leaving

Employer & Post From: To: Salary:

Brief outline of duties

Reason for leaving

Continue on a separate sheet if necessary

Professional qualifications and training

Dates Organisation Qualification

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EducationIn chronological order – most recent first

From To School/College/University Qualifications (please state subject and grade)

Do you have any special access requirements?

YES / NO

If YES, please give brief details:

ReferencesPlease give names, addresses and occupations of at least two persons to whom reference may be made. Please state your relationship with referees; at least one must be your present employer.

Name: Name:

Relationship: Relationship:

Email address: Email address:

Address: Address:

May we approach your present employer for a reference before interview? YES / NO

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Statement in support of application – please use this space to state your reasons for applying for the post, relating your skill, experiences and personal qualities to the job requirements (continue on a separate sheet if required).

I declare that the statements made by me are true to the best of my knowledge.

Signature Date

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Forms to be returned/emailed to:

Claire DeftyOperations LeadTIN Arts LimitedOld School HouseFront StreetFramwellgate MoorDurhamDH1 5BLTel: 0191 3840728

Email: claire@tinarts.co.uk

Deadline for applications: 12.00 noon on Monday 22nd September 2014

Interviews will be held on Friday 26th September 2014

If you are successful in securing an interview, you will be notified by Tuesday 23rd September 2014.

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Equal Opportunities

You do not have to give us the following information but we would be very grateful if you would answer the questions below. Any information provided may be used for monitoring and reporting. We will not use this information to assess your application.

1. Please mark the box that best represents you.

WhiteBritish

Irish

Asian or Asian British

Asian Bangladeshi

Asian Indian

Asian Pakistani

Any other Asian background

Black or Black British

Black African

Black Caribbean

Any other Black background

Chinese

Asian and White

Black African and White

Black Caribbean and White

Chinese and White

Any other background from more that one ethnic group

Any other ethnic group (please give details)

2. Do you consider yourself to be disabled?

Yes No

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