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APPLICATION FOR EMPLOYMENTUniversity of London

Thank you for your interest in The Courtauld Institute of Art. Please use black ink or type in space provided.

To comply with the Data Protection Act 199! the information you provide will be kept for the purposes of

monitorin" and will be copied for use durin" the recruitment process. #nce the recruitment process iscompleted! the data will be stored for a ma$imum of si$ months and then be destroyed. If you are thesuccessful candidate! relevant information will be taken from this form and used as part of your %& record.'here a yes(no answer is re)uired please enter a tick in the bo$.

Post applied for*

Department*

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PERSONAL DETAILS

+urname ,-#C/ 0TT0&+ Title

2orenames Home:Telephone*

Te$tphone*

2a$*

Work:

Telephone*

Te$tphone*

2a$*

Address 3obile* 0mail*

We may need to contact you during office hours (with discretion)

4ational Insurance 4umber

Do you re)uire a work permit to work in the 5/67es 4o

EDUCATION/QUALIFICATIONS/TRAINING

+tartin" with the most recent! please "ive details of your education and trainin".

+chool(Colle"e(

5niversity(Provider

Dates

2rom To 8ualifications "ained with "rade! if any

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Please "ive details of any relevant vocational or nonvocational trainin" you have received! includin"

membership of professional institutes.

EMPLOYMENT HISTORY

Please "ive details of all positions held since completin" your fulltime education! startin" with your

most recent position. If you have no employment record! include details of other work ,e.". voluntary

work.

From To Employer Po!"!o# $#% &ey

Repo#!'!l!"!e

Re$o# (or

Le$)!#*

E+PERIENCE, S&ILLS AND &NOWLEDGE

T-! ! $ )!"$l p$r" o( "-e $ppl!.$"!o# Ple$e re$% "-e *0!%$#.e #o"e e#.loe% 1!"- "-! (orm'e(ore .omple"!#* "-! e."!o#7ou should show how you meet the re)uirements of all the person specification criteria in the same orderas set out by providin" details of your knowled"e! skills and e$perience "ained in employment! voluntarywork or elsewhere.

No E2per!e#.e, k!ll $#% k#o1le%*e

Please continue on a separate sheet if necessary

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REFERENCES

Re(ere#.e -o0l% #orm$lly 'e 1ork3rel$"e% re(ere#.e $#% !#.l0%e yo0r pree#" employme#"

4or yo0r mo" re.e#" employer5 or .o0re "0"or !( .0rre#"ly $ "0%e#"

4ame

PositionAddress

Telephone 0mail

2or academic posts*

Do we have permission to contact this referee before the interview6 7es 4o

2or nonacademic posts* references are re)uested after appointment

4ame

Position

Address

Telephone 0mail

2or academic posts*

Do we have permission to contact this referee before the interview6 7es 4o

2or nonacademic posts* references are re)uested after appointment

4ame

Position

Address

Telephone 0mail

2or academic posts*

Do we have permission to contact this referee before the interview6 7es 4o

2or nonacademic posts* references are re)uested after appointment

ADDITIONAL INFORMATION

%ave you worked for the Institute before6 7es 4o

If so! please state dates and departments in which you worked! if not "iven above.

If you have answered yes to this )uestion! the department will be consulted about your employmentrecord.

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%ave you had any criminal convictions6 7es 4o

(Subject to the terms of the Rehabilitation of Offenders Act !"#$ under which you do not have todeclare s%ent convictions& 'riminal records will be taen into account only when the conviction isrelevant& eclaring a conviction will not %revent you from being considered for a %ost&)

If you have selected %uman&esources 3ana"er! Private and Confidential! Addressee #nly?.

%ave you ever been dismissed from a previous employment6 7es 4oIf yes! please "ive further details.

If you have answered yes to this )uestion! the employer may be consulted about your employment

record.

If you were appointed! when would you be able to take up the post6

'here did you see the post advertised6

Please tell us if there is anythin" we need to know in order to provide you with a fair interview! for

e$ample! communication support! audio transcription! wheelchairaccessible interview room*

2or monitorin" purposes! please complete the attached 0)ual #pportunities form and return it to us.Appointments are sub@ect to acceptable references. If you have not heard from The Courtauld within days of the interview date ,if specified! it will be because we have decided not to take your applicationany further. If you would like us to acknowled"e receipt of your application! please enclose a stamped

addressed envelope. Please note that The Courtauld does not have the resources to provide feedbackat this sta"e of the selection process.

I confirm that the information I have "iven in this application for employment! includin" any supportin"documents! is correct and complete. I understand that false or misleadin" information or failure todisclose a conviction as defined above! will nullify any subse)uent contract of employment. I alsounderstand that the information may be entered onto a computer and under the terms and conditions ofthe Data Protection Act will be treated in a secure and confidential manner.

+i"nature ..................................................................................................................................................

Date ..........................................................................................................................................................

*lease return this a%%lication form$ together with any su%%orting documentation$ by the closing date$to+recruitment,courtauld&ac&u

-he 'ourtauld .nstitute of Art %romotes e/ual o%%ortunities

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