Meningitis Research Foundation
Private and confidential
Application for employment
This form allows you to tab between editable cells. Cells will expand as needed. Please rename the file with your own name
before returning to us. If you require a paper version of this form, please contact us.
Position applied for
Position
Full name
First Middle Last
Address (including postcode)
Address 1
Address 2
City
POST CODE
Mobile number
Other telephone
Email address
@
Would you be available for
interview on planned dates?
Yes/No
Comment if necessary
When would you be free to
take up a new appointment?
Where did you learn of this
post?
Our website☐
Job Website☐ Please specify
Newspaper☐ Please specify
Other
I declare that the information provided in this application is to the best of my knowledge
correct and, if appointed, will form part of my contract of employment.
Signed
Please type your name here or print and sign
Date
Click here to enter a date.
For office use
Date received
Candidate no
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Meningitis Research Foundation
Private and confidential
References
Please give names and addresses for two referees.
We will contact your referees only if you are appointed and then only after an official offer
of employment has been issued.
Referee 1 (manager at present or last employer)
Full name
Position
Organisation
Address
Telephone number
Email address
@
Referee 2 (personal referee – must be different to above)
Relationship to referee
Full name
Position
Organisation
Address
Telephone number
Email address
@
Present employment
(If now unemployed, details of last employment)
Employer name
Address
Start date
End date
Job title
Salary
Please provide a description of the role, your responsibilities, and achievements, and give
your reasons for seeking new employment.
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Employment history
Please give brief details of your previous employment (most recent first).
Employer 2 name
Address
Start date
End date
Reason for leaving
Job title
Please provide a brief description of the business, your job title and your role.
Employer 3 name
Address
Start date
End date
Reason for leaving
Job title
Please provide a brief description of the business, your job title and your role.
Employer 4 name
Address
Start date
End date
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Reason for leaving
Job title
Please provide a brief description of the business, your job title and your role.
Please provide further brief details of any other previous work below, including any
voluntary positions you feel are relevant.
Education and qualifications
Please give details of your education and qualifications (most recent first).
School/institution name
Examinations passed/qualifications obtained
1
2
3
4
Please give details of any other qualifications obtained, courses attended, or membership
of relevant bodies you feel are relevant below.
Computer literacy
Microsoft Word Little/no experience
Microsoft Excel Little/no experience
Microsoft OutlookLittle/no experience
Database PackageLittle/no experience
Please add any other relevant details about you IT or computer experience below.
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Meningitis Research Foundation
Private and confidential
Additional information
Please use the following space to give any additional information that you feel may be
helpful in support of your application.
[please continue on a separate sheet or extend this box, if necessary]
Do you have a current driving
licence?
Yes/No
Does it contain any
endorsements?
Yes/No
If yes to above please give
details
Do you have unrestricted use
of a car?
Yes/No
On occasions you may be
required to use your car on
charity business, is this ok?
Yes/No
Do you have any criminal convictions (other than those spent under the rehabilitation of
offenders act) Yes/No
If yes to the above, please give details
Have you been subject to any disciplinary procedures in your current or any previous
employment? Yes/No
If yes to the above, please give details
For foreign nationals:
Do you require a work permit? Yes/No
If no, do you have permission to live and work in the UK Yes/No
If yes give details
Please note that we are unable to accept applications for this post from candidates who
do not already have the right to work in the UK
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Meningitis Research Foundation
Private and confidential
Equal Opportunities
This form will be detached from your application and will be treated in strict confidence.
Meningitis Research Foundation is committed to promoting fairness and eliminating
discrimination from recruitment and selection practices. We will ensure that no job applicant
or employee received less favourable treatment either directly or indirectly, on the grounds of
age, race, disability, gender, marital status, religion or faith or sexual orientation.
You are not obliged to complete this form. If you do, you will be aiding us to monitor and
audit the effective delivery of this commitment. This form will only be used for this purpose,
will form no part of the interview process.
Gender
Male☐
Are you married or in a civil
partnership?
Yes☐
Age
16-24☐
Female☐
No☐
Prefer not to say☐
Prefer not to say☐
25-34☐ 35-44☐ 45-54☐ 55-64☐
Prefer not to say☐
Ethnicity
Ethnic origin is not about nationality,
place of birth or citizenship. It is
about the group to which you
perceive you belong. Please tick the
appropriate box
Asian/Asian British
Indian☐ Pakistani☐ Bangladeshi☐ Chinese☐
Any other background
Prefer not to say☐
Black/African/Caribbean/Black British
African☐ Caribbean☐
Any other background
Prefer not to say☐
Mixed / multiple ethnic groups
White and Black Caribbean☐
White and Black African☐
Any other background
Prefer not to say☐
White and Asian☐
White
English☐ Welsh☐ Scottish☐ Northern Irish☐
Irish☐ British☐ Gypsy or Irish Traveller☐
Any other background
Prefer not to say☐
Other Ethnic Group
Arab☐
Any other ethnic group
Prefer not to say☐
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Meningitis Research Foundation
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Do you consider yourself to have
a disability or health condition?
Yes☐ Please specify
No☐ Prefer not to say☐
What is your sexual Orientation?
Heterosexual☐
Gay woman/lesbian☐
Gay man☐
Bisexual☐
Other
Prefer not to say☐
What is your religion or belief?
Buddhist☐
Christian☐
Hindu☐
Jewish☐
Muslim☐
Sikh☐
Other
Prefer not to say☐
Please return this form along with your application to [email protected] or post to
Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
Further information on the charity can be found at www.meningitis.org
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