Application For Employment Confidential |

Position Applied for*
Personal Details
Your Name*
Title Surname Forename(s)
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Telephone numbers:
Home:*
Work:*
(only if we may telephone you there)
Mobile:*
Email:*

References
Please give the names and contact details of two referees whom we can contact to provide information in support of your application. One of these should be your current manager: if you are not in employment, please supply the name of your most recent employer or an academic reference (e.g. tutor or teacher). As such, Severn Arts implements a Safer Recruitment Policy. This requires references to be taken up once applicants have been shortlisted for interview. Please indicate here if you have any concerns about references being taken up at shortlisting stage. Please ensure that your referees are aware of this application, and also, if you are providing us with their email address, that you obtain your referee's permission.
First Reference
Name*
Title Surname Forename(s)
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Email*
Position held in relation to applicant*
Referees may be contacted prior to offer being made*
Second Reference
Name*
Title Surname Forename(s)
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Email*
Position held in relation to applicant*
Referees may be contacted prior to offer being made*

REHABILITATION OF OFFENDERS ACT 1974
Applications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this job will not be taken into account. You are required to disclose any convictions, which are not 'spent' by virtue of the Rehabilitation of Offenders Act 1974.
Have you ever been convicted of a criminal offence, which is not spent, as defined in the above Act?*
Details of Offence*
If "Yes", please give details of date(s), offence(s) and sentence(s) passed. If "No", please write N/A
Please also confirm that you are not listed on either of the following (as appropriate):*
- I confirm that I am not listed on the children's barred list.
- I confirm that I am not listed on the adults' barred list.
- I declare that I have no past convictions, cautions or bind-overs and no pending cases affecting why I might be considered unsuitable to work with children/vulnerable adults.
The information you provide will be treated as confidential and will be considered only in relation to the job for which you are applying.

Equal Opportunities
We aim to be an equal opportunities employer, and our policy is that job applicants and employees receive equal treatment regardless of sex, race, disability, sexual orientation, religion or belief, age, marital status or civil partnership, pregnancy/maternity or gender reassignment, where any of these cannot be shown to be a requirement of the job concerned. Recruitment, selection and promotion procedures will be monitored to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities. To assist us in monitoring the operation of our equal opportunity policy, and for no other reason, please answer the following questions.
Sex*
Age*
Do you consider yourself to have a disability?*
If yes, please give brief details of the disability and any adjustments that would need to be made to enable you to carry out the duties listed for this post.
Race*
Please State Other Background Here:*
Sexual Orientation*
Religion*
Please State Other Religion Here:*

Training / Professional Membership
It is our policy to verify professional membership details of successful applicants, where these are a requirement of the role.
Course/Organisation (with brief details after each line):
Personal Statement*
With reference to the person specification, please explain why you consider yourself to be a suitable candidate for this position, including examples of you relevant achievements, as well as what motivates you to apply.

DATA PROTECTION STATEMENT
Information from this application may be processed for purposes permitted under the General Data Protection Regulation. Individuals have, on written request, the right of access to personal data held about them. Severn Arts treats personal data collected during the recruitment process in accordance with its Privacy Statement. Information about how your data is used and the basis for processing your data is provided in this privacy statement, available on the Severn Arts website.
DECLARATION
I confirm that the above information is complete and correct and that any untrue or misleading information will give Severn Arts the right to terminate any employment offered. I understand that any offer of employment is subject to Severn Arts being satisfied with the result of a series of relevant checks including references, eligibility to work in the UK, criminal convictions, probationary period and a medical report (in line with the operation of the Equality Act 2010).
If you have a disability, and there are any special arrangements which need to be made should you be short-listed for interview, please contact us to notify us of these. All information given is private and confidential.
Signed (full name):*
Date:*
Date Format: MM slash DD slash YYYY

Personal Details