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* 1. Email Address

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* 2. Role Applying For

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* 3. We would like to get to know you a little more. Please tell us why you would like to work for the ELR and provide details of your availability as much as possible.

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* 4. Preferred title

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* 5. Surname

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* 6. Forename(s)

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* 7. House Number/Name

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* 8. Street Name

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* 9. Town/City

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* 10. County

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* 11. Postcode

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* 12. Contact Number

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* 13. How did you find out about this role?

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* 14. Marital Status

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* 15. Do you consider yourself to have a disability/impairment as defined in the Disability Discrimination Act 1995

The Disability Discrimination Act 1995 defines a disabled person as someone with a physical or mental impairment, which has substantial and long-term adverse effect on his/her ability to carry out normal day to day activities.

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* 16. If yes, do you consider yourself to have any of the following disabilities/impairments as defined in DDA?

References
Please give the name of two referees, one of which should be your current or last employer if you have been employed recently. If you have not been employed recently refer to the guidance notes. You may choose your second referee.
Referee 1

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* 17. Name

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* 18. Job Title

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* 19. Address

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* 20. Postcode

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* 21. Email Address

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* 22. Telephone Number

Referee 2

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* 23. Name

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* 24. Job Title

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* 25. Address

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* 26. Postcode

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* 27. Email Address

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* 28. Telephone Number

Present Employer

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* 29. Job Title

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* 30. Name of Employer

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* 31. Address of Employer

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* 32. Postcode

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* 33. Date Started

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* 34. Salary/Wage

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* 35. Notice Required

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* 36. Description Of Your Current Role

Previous Employment
Please list in date order, starting with the most recent any previous employers, including company name and address. Please detail your role, its responsibilities and the date you commenced and finished employment.

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* 37. Please list in date order, starting with the most recent any previous employers, including company name and address. Please detail your role, its responsibilities and the date you commenced and finished employment.

Education
Please list any Schools/Academies attended from high school and any appropriate qualifications.

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* 38. Please list places attended and qualifications gained

Further Education
Please indicate college and university courses, any training related to your employment and qualifications (including grades).

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* 39. Please list any Colleges/Universities, dates attended and relevant qualifications

Other Training
(Please list any training and development that you have undertaken in the last 5 years that is relevant to your application) 

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* 40. Please give details of any other training relevant to the post you are applying for not covered in previous sections (e.g. short courses)

Relevant Skills, Knowledge and Experience

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* 41. Tell us why you are applying for this role and what you think you will bring to the ELR

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* 42. What relevant work experience (paid or unpaid), background knowledge and or/relevant skills do you have?

General Information

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* 43. Are you in possession of a current driving licence?

Criminal History

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* 44. Have you ever been convicted of a criminal offence?

Declaration subject to the requirements of the Rehabilitation of Offenders Act. 

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* 45. If yes, please give details:

Right to Work in the United Kingdom

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* 46. Do you need a permit to work in the UK?

Declaration
Data Protection Act 1998: The Company maintains a Register Entry in respect of Staff Administration. Personal information provided by you on this form and any others in connection with your application is treated in confidence and complies with the requirements of the Act.
Verification of Information: The Company may verify information you have provided on the Application form (e.g. Qualifications, Skills, Knowledge, Experience and Salary) either prior to the interview or as part of the appointment process. This may involve contacting organisations or persons you have named on the form. You will have the opportunity to make representations should any checks produce discrepancies. 
Asylum and Immigration Act 1996: It is a criminal offence to employ a person who is subject to immigration control, unless they have documentation which permits them to work in the UK. You should therefore be aware that we will make checks to ensure that you are eligible to work in the UK. 

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* 47. I have read the above and agree to the contents

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* 48. Today's Date

Date

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