Application Form

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Personal Details

Post Applied for: *

Where did you first see the post advertised?*

Title: *

Surname: *

Forename(s): *

Gender: *

Date of Birth: *

I am: *

Home Address Line 1: *

Home Address Line 2:

Home Postal Code: *

Country: *

U.S.State:

Telephone Number: *

Mobile Number: *

E-mail: *

Work Address Line 1:

Work Address Line 2:

Work Postal Code:

Work Telephone Number:

Work Email:

May we contact you by telephone or email at work? (please indicate as appropriate)

Period of notice in present post: *

Are you over 16 and under 65? *

Are you in good health? *

If you answered NO above please state the reason(s)

PRAESIDIUM INTERNAL DISABILITY DISCRIMINATION ACT PROCEDURES

Praesidium wishes to ensure that disabled people are not discriminated against, either directly or indirectly, both in recruitment/selection and in employment. If you are selected for interview and you consider yourself to be disabled, we may contact you to find out if there are any particular arrangements you may need for the interview. You are not obliged to answer the following question or to give details.

Do you consider yourself to be disabled?

How many days sickness absence have you taken in the last two years? *

Have you ever been convicted of a criminal offence? *

If Yes, please give details:

Have you applied to/been employed by Praesidium before? *

If Yes, please give details/dates:

Please give your present/last annual salary and details of any additional benefits/allowances:*

If appropriate, please describe any requirements which may be necessary for an interview.