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Reference Number
Post Title
Faculty/Department
If you saw this advertisement elsewhere please state in which publication you saw it.

Applications from disabled candidates are welcomed. Please let the Human Resources Team know if you need assistance to complete this form.

Title	If other please specify
First Names
Surname
Address (include Post Code)

Home Telephone Number (inc STD code)
Daytime Telephone Number (inc STD code)
Are you a licensed car driver?	Yes No
Email Address
Please state your National Insurance Number
Salary in present post and any associated benefits
Period of notice required in present post
Are you disabled? If Yes you are invited to give details on the Equal Opportunities Questionnaire supplied.	Yes No

Dates (mm/yyyy)		Employer’s name and address and nature of business	Post held and description of duties	Reason for leaving	Salary on leaving
From	To

Schools attended			Examinations Passed
Dates (mm/yyyy)		Name and type of school	Date (mm/yyyy)	Gcse,GCe,etc	Subject	Grade of pass
From	To

University, Polytechnic, Technical or Art College, Correspondence Courses, etc
Dates (mm/yyyy)		Name of Institution	Qualifications obtained	Grade of pass
From	To

Name and Institution or Correspondence College	Title and nature of course	Dates (mm/yyyy)

Name of Institution	Membership status or grade	Admission date (mm/yyyy)

1. Name		Please do not contact this referee prior to interview
Job Title
Organisation
Address
Telephone Number
Fax Number
Email Address
Please state capacity in which referee is known

2. Name		Please do not contact this referee prior to interview
Job Title
Organisation
Address
Telephone Number
Fax Number
Email Address
Please state capacity in which referee is known

Are you related to any employee of De Montfort University?	Yes No
If yes, in what capacity?
If you are not an EU National, do you have permission to work in the UK?	Yes No
Disability is not a bar to employment or career prospects with De Montfort University. All disabled applicants will be considered for interview and if invited may be accompanied by someone of their choice. If appointed to the post occupational aids and adaptations to the premises will be sought, where appropriate.
Have you ever been convicted of a criminal offence?	Yes No
If Yes, please give details: Disclosure is not required where the conviction is spent under the Rehabilitation of Offenders Act 1974, subject to excepted classes.

POLICY

The policy of De Montfort University is that no person should be discriminated against by reason of their race, colour, ethnic or national origin, nationality, religious belief, gender, marital status, sexual orientation, age, hours of work, disability or union membership/non membership.
It is the policy of the University that all decisions taken in respect of recruitment, promotion and training shall be taken having regard only to the requirements of the job or training proposed.

MONITORING

For the Policy on Equality of Opportunity in Employment to be effective, the University will monitor the profile of applicants and those appointed by age, disability, gender and ethnic origin. You are, therefore, requested to complete the questions below. The information is for statistical purposes only and WILL NOT be passed on to those involved in the selection procedure. The information you give will be treated as confidential.

Reference Number
Post applied for
Faculty/Department
Date of Birth
Sex	Male Female

The DDA defines a disability as "physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities".
Do you have a disability?	Yes No
If yes, you are invited to give details:

Asian or Asian British
Bangladeshi
Indian
Pakistani
Asian Other
Please specify

Black or Black British
Black African
Black Caribbean
Black Other
Please specify

White or White British
White British
White Irish
White Other
Please specify:

Chinese or other Ethnic Group
Chinese
Any Other
Please specify:

Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Please specify:

Name

By submitting this form you are declaring that the information given in this application is true. Once you have pressed submit you will receive an automatic acknowledgement. If you have not received this within 24 hours, please contact Human Resources (see contact details below).

In the interests of economy we do not contact applicants who have not been short listed for interview. If you do not hear from us within 20 working days of the closing date of the vacancy, please assume that you have not been short listed on this occasion.

For further information call the Human Resources team on 0116 250 6018 or email vacancy@dmu.ac.uk