application form - Portsmouth Guildhall

POST TITLE:
PERSONAL DETAILS
Name:
Address:
Contact details
E-mail:
Telephone Home:
Telephone Work:
Mobile:
WORK EXPERIENCE
Let us know about any jobs that you have had or any voluntary work that you have taken part in
(this could be helping to run a school event, work experience etc.)
Name and full address of
place of work.
What was your job title,
what did you do and what
do you think you were good
at?
Reason for leaving and date of
leaving
QUALIFICATIONS
Please detail any school, higher or further education qualifications that you have (GCSE’s, ALevels, BTEC, Degree etc.) including the grade you achieved.
In this section, we want to find out more about you. Look at the job description and
tell us how you feel you meet the ‘person specification’.
Think about any relevant experience from school/ work/ volunteering or other activities which
you feel will support your application.
Please tell us why you would like this internship:
How do you think you meet the person specification that we set out in the job
description:
(Please continue on a separate sheet if necessary, giving page number and title heading.)
Other information
Please let us know of any other information that might be relevant to your application.
References
Please give us details of two people for references. These people should not be family members;
one should be your most recent employer or teacher/ lecturer. Referees will not be contacted
unless you are successful at interview.
Referee One
Referee Two
Name:
Address:
Name:
Address:
Phone number:
Email:
Phone number:
Email:
Relationship to you:
Relationship to you:
I give/do not give permission to take up my reference prior to an offer of employment being made.
(Please delete clearly as appropriate)
Have you ever been convicted of a criminal offence?
(declaration subject to the Rehabilitation of Offenders Act 1974)
If yes, please provide details
YES/NO
Are there any medical conditions that you suffer from that we should know about that
would prevent you from doing something essential to the job?
If yes, please can you outline the medical condition(s)?
Do you consider yourself to be disabled under the Equality Act 2010? If you have a
disability please tell us about any adjustments we may need to make to assist you at
interview
Right to work in the UK
Right to work
If you are selected for interview, please be prepared to bring with you, evidence of your right to
work in the UK. This is required under the Immigration (Restrictions on Employment) order 2003.
For more information please visit www.legislation.gov.uk/uksi/2007/3290/contents/made
Please bring a passport and proof of address
OR
A Birth Certificate, Proof of NI number from HMRC and Proof of address
Data Protection
The information provided on this application may be stored and processed by Portsmouth Cultural
Trust for a period of six months for recruitment purposes and if successful the information
will be stored on personal file and processed for the purpose of the employment relationship.
Portsmouth Cultural Trust keeps personal information on all employees and provides such
information only on a need to know basis. By accepting a job offer, employees agree to our
retaining such information, which can include sickness and health records, ethnic origin, trade union
membership and disciplinary matters. Once a year without charge employees can inspect their
records and, if necessary, request correction of any faulty records
Equal Opportunities
Portsmouth Cultural Trust is an equal opportunities employer and is committed to ensuring that
our recruitment process is open, fair and not influenced by irrelevant considerations. To that end
an Equal Opportunities Recruitment Monitoring Form is attached.
Declaration
All claims and/or statements of skills, experience, qualifications and employment will be checked. In
the event of false claims being made, any offer of, or employment will be terminated. Portsmouth
Cultural Trust reserves the right to recover from an applicant/employee any costs incurred as the
result of the employment of someone who has submitted an application form (or other evidence of
experience) containing false claims
To the best of my knowledge I declare that the information contained in this application form is
accurate and correct.
I understand and agree that:
a) The provision of false information may result in disqualification from the recruitment process
or termination of employment.
b) Where I cannot provide evidence of qualifications, suitable references and/or the right to
live and work in the United Kingdom the offer of employment may be rescinded and/or
employment terminated.
c) Under the Rehabilitation of Offenders Act (if it applies to the post for which I am applying)
failure to disclose any convictions spent or otherwise will result in non appointment or
disciplinary action and potential dismissal.
d) Where the post for which I am applying requires a background check, I hereby agree to the
relevant check being made by the relevant organisation about the existence and content of a
criminal records spent or otherwise.
e) The Trust does not acknowledge receipt of application forms.
PLEASE SIGN AND DATE ON NEXT PAGE
Signed:
Printed name:
Date:
Once you have completed all three parts of this application form please:

e-mail: to hayley.reay@portsmouthguildhall.org.uk
If you are selected for interview, you will be required to sign this form before
the interview in order to confirm that all the information provided is correct.
OR

post : to Hayley Reay, Portsmouth Cultural Trust, Portsmouth Guildhall, Guildhall Square,
Portsmouth, PO1 2AB
THIS PAGE IS INTENTIONALLY LEFT BLANK
Equal opportunities monitoring form
UNIQUE IDENTIFICATION NUMBER:
(Please leave blank)
This section of the application form will be detached and used solely for monitoring purposes.
Portsmouth Cultural Trust recognises and actively promotes the benefits of a diverse workforce
and is committed to treating all employees with dignity and respect regardless of race, gender,
disability, age, sexual orientation, religion or belief. We therefore welcome applications from all
sections of the community.
Please tick the boxes which describe you most closely:
Date of birth
Gender:
for monitoring purposes only
Male

Female 
Prefer not to say 
What is your ethnicity?
Ethnic origin categories are not about nationality, place of birth or citizenship. They are about
the group to which you as an individual perceive you belong.
Please indicate your ethnic origin by ticking the appropriate box below.
Arab – Middle Eastern 
Mixed – White and Black African 
Arab – North African 
Mixed – White and Caribbean 
Asian or Asian British – Bangladeshi 
Other Asian Background 
Asian or Asian British – Indian 
Other Black background 
Asian or Asian British – Pakistani 
Other Ethnic background 
Black or Black British – African 
Other Mixed background 
Black or Black British – Caribbean 
Other White background 
Chinese 
Japanese 
Latin American

Mixed – White and Asian 
If any ‘other’ category ticked, please specify if you
wish:
White - British 
White - Irish 
Prefer not to say 
What is your sexual orientation?
Bisexual 
Gay man 
Gay woman/lesbian 
Heterosexual/straight 
Other 
Prefer not to say 
What is your religion or belief?
Buddhist 
Christian 
Hindu 
Other 
If any ‘other’ category ticked, please specify if you
wish:
Jewish 
No religion 
Muslim 
Prefer not to say 
Sikh 
Disability
Definition of Disability – The Equality Act 2010 defines disability as ‘A 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.’ Long term in this context means likely to last longer than 12
months or likely to recur. Please note that cancer, HIV and multiple sclerosis are covered by
the Act from the point of diagnosis.
Do you have a disability as defined in the Equality Act 2010?
Yes 
No 
Prefer not to say 
If yes, please state the nature of your disability or long term condition: