AURION LEARNING APPLICATION FORM

APPLICANTS PLEASE NOTE: Each section of this form must be fully completed. If you are completing a paper-based version of this form, please complete in black pen and if you find you do not have sufficient space to complete a section, please use additional sheets of paper attached to the application form.

ANY INFORMATION NOT INCLUDED ON THE APPLICATION FORM WILL NOT BE ACCEPTED

Please state where you saw this post advertised: ……………………………………………………………….

APPLICATION FOR: INSTRUCTIONAL DESIGNER Closing Date of: 3rd February 2012 Receipt: 4.00pm Date of Application:

Surname: First Name: Mr Mrs Miss Ms Address: Nationality: Citizen of EC Country

YES NO Non EC: (Please State Country of Citizenship) Post Code: Day Time Tel No: Evening Tel No:

Please give details of any illness, operations, and accidents, if any, which necessitated your absence from employment / college for more than a two-week period at any one time during the past three years.

Please name two referees (not relatives or employees of the Company) one of whom should have knowledge of you as an employee and be in a supervisory / managerial capacity. Name: Name: Address Address

Post Code: Post Code: Day Time Tel No: Day Time Tel No: Occupation: Occupation:

Signature: Return not later than 4.00pm on the closing date to: Aurion Learning Date: Monitoring Officer 475 Ormeau Road CANVASSING WILL DISQUALIFY Belfast BT7 3GR

Please ensure that you have completed all relevant parts of this application form including the Equal Opportunities Monitoring Form. A Candidate found to have knowingly given false information or to have wilfully suppressed any material fact will disqualify themselves from the recruitment process or, if already appointed, may be dismissed.

QUALIFICATIONS Please list separately all qualifications obtained. Subject Level & result / grade MUST ALL BE COMPLETED.

CERTIFICATES TO BE PROVIDED IF SHORT LISTED

Level/Stage e.g. GCSE, “A”, Degree etc. Result obtained Subject & Training Programmes e.g. A, B, C, 2:1 etc

If you have listed a non UK qualification please state level and grade obtained in qualification gained PROFESSIONAL QUALIFICATIONS (Professional and Technical Staff should ensure that relevant Registration and Membership Numbers are quoted in this section) Name of Part No Final Registration No Examinations Profession with result with result (if applicable) yet to be taken al Body

Do you hold a currentDo you full have UK access to a motor vehicle for business purposes? Driving Licence? Yes No Yes No EMPLOYMENT Please give full details of your employment record including levels of responsibility. Please start with your current or most recent employer.

Dates: From: Employer Job Title To: Main Responsibilities

Reason for Leaving Salary Dates: From: Employer Job Title To: Main Responsibilities

Reason for Leaving Salary

Dates: From: Employer Job Title To: Main Responsibilities

Reason for Leaving Salary

(Please continue on a separate sheet, if necessary)

EXPERIENCE / KNOWLEDGE SKILLS Please state in the table below, how your skills and past experience enable you to meet the criteria for the post. CRITERION SKILLS / PAST EXPERIENCE (Please continue on a separate sheet, if necessary)

DISABILITY DISCRIMINATION ACT 1995

Do you require any special arrangements to be made to assist you if called for interview? Yes / No

If Yes, please provide details: Employee Applicant Monitoring Questionnaire

We are an Equal Opportunities Employer and do not discriminate on grounds of religious belief or political opinion. We practice equality or opportunity in employment and select the best person for the job.

In accordance with the Fair Employment and Treatment (NI) Order 1998, Aurion is required to monitor the perceived religious affiliation/community background of its employees and applicants. In accordance with the Monitoring regulations we are asking you to indicate which community you belong to by ticking the appropriate box below:

I am a member of the Protestant Community

I am a member of the Roman Catholic Community

I am a member of neither the Protestant nor the Roman Catholic Community

Please indicate whether you are Female Male

If you are unable to determine your community background from the form, we shall use the residuary method to make a determination on the basis of information contained in your application for this post.

Please note: It is a criminal offence under the legislation for a person to “give false information … in connection with the preparation of the monitoring return”.

The above information will NOT be used as part of the application process.

The Monitoring Form should be returned to:

Monitoring Officer Aurion Limited 475 Ormeau Road Belfast BT7 3GR

Tel: 028 9064 3211 Email: [email protected]