<p> Internal ref: </p><p>PERSONAL DETAILS (PRIVATE AND CONFIDENTIAL)</p><p>Job title: Closing date: Where did you hear about this vacancy?</p><p>Personal Details This information is detached prior to your application being considered Title First name(s) Surname Preferred Name</p><p>Address Email address Preferred method of contact: E-mail Telephone Phone Post Postcode Mobile Date of birth Gender National Insurance number</p><p>Do you have the legal right to work in the UK? Yes No If ‘Yes’ and there are conditions attached, e.g. start and finish dates, please specify:</p><p>If ‘No’ what type of work permit do you require?</p><p>References Please provide an email address as first point of contact for referees Name Position/occupation Address Email Relationship Length of time you have known this person Postcode May we contact this person prior to interview? Yes No </p><p>Name Position/occupation Address Email Relationship Length of time you have known this person Postcode May we contact this person prior to interview? Yes No </p><p>Name Position/occupation Address Email Relationship Length of time you have known this person Postcode May we contact this person prior to interview? Yes No Disability Do you consider yourself to have a disability? Yes No If ‘Yes’ please state the nature of the disability. Would you need any adjustments to be made to allow you to successfully perform this role? </p><p>Do you need any special assistance in attending interview? If so, please give details:</p><p>The Disability Discrimination Act 1995 defines a disability as a physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities. </p><p>Have you ever been convicted of a criminal offence? Yes No (Declaration subject to the Rehabilitation of Offenders Act 1974, enclosed) Ethnicity Which is your ethnic group? A White White British White Irish Gypsy or Irish Traveller Any other White background B Asian or Asian British Indian Pakistani</p><p>Bangladeshi</p><p>Any other Asian background C Mixed Mixed White & Black Carribbean Mixed White & Black African </p><p>Mixed White & Asian </p><p>Any other Mixed background D Black or Black British Black or Black British African Black or Black British Caribbean Any other Black background E Chinese or other ethnic group Chinese</p><p>Any other ethnic group Please specify</p><p>Sexual Orientation Heterosexual Homosexual Bisexual Other Prefer not to say </p><p>Religion Christian Buddhist Hindu Jewish Muslim Sikh No religion Other </p><p>Medical Information Please comment on your current health status if you feel this would be helpful:</p><p>In accordance with the Data Protection Act 1998, the information provided on this form will be used in the recruitment and selection process and may be disclosed to those who need to see it. It will also form the basis of the confidential HR record of the candidate. In the case of unsuccessful candidates, the Personal Details and Application Form will be destroyed after 6 months. I hereby declare that to the best of my knowledge, all the information given by me is correct and that I possess all the qualifications I have listed on this form. I agree that the Theatre Royal Plymouth Ltd ha the right to validate any of the information provided. I understand that any false statements could results in my dismissal, if appointed.</p><p>Signed: Date APPLICATION FORM Please refer to our guidance notes before completing in blue or black ink Employment History Please provide information on your most relevant employment, starting with the most recent Employer Job title Start End Reason for leaving Rate of date date pay</p><p>Please give details of your two most recent or relevant positions Employer Dates employed</p><p>Job title Notice period Summary of duties</p><p>Reason for leaving</p><p>Employer Dates employed</p><p>Job title Notice period Summary of duties</p><p>Reason for leaving</p><p>Educational, technical and professional qualifications</p><p>Academic/personal qualifications attained or working towards - most recent first Place of study/professional body Subject Attainment level or Date gained result</p><p>Other relevant development or training – most recent first Course name and details Date Professional membership Memberships of professional bodies/institutes/associations or relevant organisations</p><p>Do you have any other work commitments, either paid or unpaid, which you would wish to continue with if offered employment? Yes No </p><p>If ‘Yes’ please provide details</p><p>Supporting Statement Please use this space to state your reasons for applying for the post, relating your skills, experiences and personal qualities to the job requirements. Supporting statement continued from overleaf (if necessary) Please return your completed application form to: HR Department Theatre Royal Plymouth Royal Parade Plymouth PL1 2TR or email it [email protected]. </p><p>INTERNAL USE ONLY Short listing: Matching abilities and skills to essential & desirable criteria</p><p>Meets Please tick Comments/feedback A=ALL B=MOST C=SOME D=NONE</p><p>Invite to interview Yes No Offer employment Yes No Start date (if applicable) ______Salary £ per annum / month / week DBS check required? Yes No </p>