Application for Employment
	
For the post of:	
Researcher / campaigner on resource democracy	

Application deadline:	
6pm (=5pm GMT), Thursday 10 May	

Please complete this form, and email (in rich text format) to info@platformlondon.org with ‘job application: [YOUR NAME]’ in the subject line. 
Please ensure that your application is received by the deadline. You may also send a cv if you wish;   but CVs on their own will not be considered. 

Supporting materials

•	I attach a sample of my writing, as requested in the job description (please tick):
One sample of writing (preferably published), which illustrates either your research abilities or your campaigning/communication abilities. This may be on any subject, and of any length. You do not need to write something especially for this application.
	
1. Personal details

Surname	

Other names	

Name you prefer to be known as (if different from first name):

Address

Telephone:  Home
                    Mobile
                    Work	

Email	

Nationality	

2. Availability

If appointed, when would you be able to start?	

Are there any dates when you would NOT be available for interview?	

National insurance (NI) number	

If you do not have an NI number, are you eligible to work in the UK?     Yes/No
If you are called for interview, and do not have an NI number, please bring proof of your eligibility.	

3. Present or most recent post

Name of employer	

Address of employer

	

Job title	

Dates of employment	
From:	
To:	

Current / final salary (gross per annum, full-time equivalent)	

Summary of responsibilities

	

Reason for leaving

4. Previous employment and voluntary work
(Please list most recent first; please indicate voluntary positions)

Employer	
Job title	
Date from	
Date to	
Reason for leaving	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

5. Languages

Please indicate level (fluent, good, intermediate, basic); list your first language (‘mother tongue’) first

Language	
understand	
speak	
read	
write	

	

	

	

	

	

	

	

	

6. Education and training

Please include formal education, professional qualifications, and any other training relevant to this post.

Institution / provider	
Course attended	
Date from	
Date to	
Qualification gained and grade (where applicable)	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

7. Other relevant skills and experience

Please list any other skills or experiences relevant to this post, not covered above. 

	

8. Supporting statement

Please write a statement to: 
a) Explain what excites you about this job, and 
b) With reference to the person specification, provide evidence from your experience, achievements and qualifications to demonstrate how you meet the requirements.
Do not exceed 1,000 words. Continue on a separate sheet if necessary

9. Referees

Please give details of three people, who are not related to you, who may be approached for references as to your suitability for this post. One should be your present or most recent employer. The second and third should be people able to judge your abilities in relation to this post. We will not contact them prior to first interviews, but may contact them before second interviews (if appropriate).

Referee 1	
Referee 2	
Referee 3	

Name	

	

Position

	

Relationship to you	

	

Email 	

	

Telephone	

	

May we contact them without further permission from you?	

	

10. Declaration

I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal. 

Name 

Date

(If called for interview, you will be asked to sign this declaration during the interview)

	

Equal Opportunities monitoring form

The following information will be used to monitor compliance with PLATFORM’s policy of ensuring we are an equal opportunities employer, and will not be used for any other purpose. This form will be separated from the application before short-listing and kept confidentially by PLATFORM.
	
Where did you see this job advertised?	

Post applied for	

Surname	

First name(s)	

Gender (M/F)	

Date of birth	

Please describe your ethnic origin by putting an X in one of the boxes below:

White	
British	

	
Irish	

	
Any other white background (please state)	

Asian or Asian British	
Indian	

	
Pakistani	

	
Bangladeshi	

	
Any other Asian background (please state)	

Black or Black British	
Caribbean	

	
African	

	
Any other Black background (please state)	

Chinese or Chinese British	
Chinese or Chinese British	

Mixed 	
White & Black Caribbean	

	
White & Black African	

	
White & Asian	

	
White & Chinese	

	
Any other mixed background (please state)	

Other background	
(please state)	

Do you consider yourself disabled? 	
Yes / No	

If yes, how would you describe your disability?	

Registration number if applicable