For office use only
CANDIDATE
NUMBER

APPLICATION FOR AN ACADEMIC POST

Application for the post of:
Ref:

Please complete this form in type or in black ink. If there is insufficient space for your information continue on a separate sheet of paper.

YOUR DETAILS
Surname:

Forename(s):

Title:

Address:

Postcode:
Home Telephone:

Work Telephone:

Mobile:

Email:

When is the best time to contact you?

REFERENCES
Name, postal address, email address and position of three persons, including your existing or last employer, to whom reference may be made in support of your application concerning your professional ability and performance at work. Please indicate if we can take up references immediately.
Refs
1. Name:
Relationship
No

Address:
Tel No:
2. Name:

Email:
Refs
No

Relationship

Address:
Tel No:
3. Name:

Email:
Refs
No

Relationship

Address:
Tel No:

ACADEMIC APPLICATION

Can we contact you at work? No

Email:

DECLARATION
I confirm that the information provided is true and correct, and understand that providing false or misleading information will disqualify me from appointment, or if appointed, could lead to termination of appointment.
Additionally, I understand that if I am applying for a post within the Brighton and Sussex Medical School (a joint venture between the Universities of Brighton and Sussex with the involvement of local NHS trusts) it may be necessary for the information I have supplied to be shared with these other organisations.
Under the terms of the Data Protection Act I give my consent, by signing below, that the information I have supplied be shared with the University of Brighton and/or local NHS trust as necessary as part of the selection process. If you have any queries about this matter, you should contact the HR Division,
University of Sussex, Tel: 01273 877769.

Signed: (type name if submitting electronically)

Date:

Where did you see this post advertised?
Please detail any other post(s) at this University for which you have recently applied?

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GUIDANCE NOTES FOR JOB APPLICANTS
Completing the Application Form
Please read the application form thoroughly and complete it in type or black ink to aid photocopying. Please ensure that you complete all sections.
Your application will be treated in the strictest confidence. Where answers require additional detail, this should be provided on the continuation sheet at the back of the form. If you wish to submit a CV, this should be provided in addition to completing the application form.
Application Forms must be completed in full. The information that you provide in your application form and other supporting information is the only information we will use in deciding whether or not you will be short listed for interview. The information on the Monitoring Form is seen by Human
Resources personnel only.

Work Record
Start with your present or last employer and then list the work you have done previously. Please detail any gaps in employment as fully as possible. If you have never been employed or have been unemployed for some time, please give details of other experience or training. Please also provide details of any unpaid or voluntary work. Further information may be added on a separate sheet if necessary.

Additional Information
Here you should explain why you should be chosen for the job. You must decide from the further particulars/job description/person specification whether you have the necessary skills and experience to apply for the position, and provide examples of how you meet the criteria of the post.

Equal Opportunities Monitoring Form
The University of Sussex is committed to equality of opportunity and will consider all applications on the basis of merit alone. We ask you to complete an equal opportunities monitoring form to help us check the effectiveness of our recruitment and equality and diversity policies.
Any personal data collected through this exercise will only be used by the University in accordance with the provisions set out in the Data Protection
Act. The University operates a strict policy entitled "Code of Practice on Handling Personal Information". This stresses that all information will be held securely and confidentially.

Disability
If you are a disabled person and you require adjustments to be made to the application or interview process please contact us to discuss your requirements. Please let us know if you require the documentation in an alternative format or by email. It would be helpful if you could contact us immediately you are notified of an interview in order that we can make any necessary arrangements for you.

Criminal Convictions
We treat this information in accordance with our obligations outlined in the Criminal Records Bureau Code of Practice and undertake to treat all applicants for positions fairly. We operate a policy on the recruitment of ex-offenders. A criminal record will not necessarily be a bar to appointment within the University.
We only need to know about 'unspent' convictions, unless the post is one that involves direct contact with children or vulnerable adults and where we need to know about all unspent or spent convictions. Disclosures of convictions may be requested from the Criminal Records Bureau in relation to posts where there is substantial direct contact with persons under the age of 18, or with vulnerable adults. Applicants will be treated on an individual basis, in relation to the specific job and the relevance of any conviction(s). A disclosure via the Criminal Records Bureau will only be sought for a relevant position once an individual has been offered a post. We will discuss the relevance of any convictions at interview. However, failure to reveal information that is directly relevant to the position sought could lead to the withdrawal of an offer of employment. If a disclosure is required and that process reveals previous convictions, the contents of the disclosure will be discussed with the applicant prior to any withdrawal of a conditional offer of employment. Information concerning convictions that is disclosed on the monitoring form will only be seen those who need to see it within the university. Information concerning applicants who are not selected will be destroyed. If you have any questions or would like to obtain a copy of the Code of Practice or the
University policy please contact Human Resources Division.

References
References will only be taken up for short listed candidates. Please give the name, address, telephone number and email address (if known) of at least two referees, including your existing or last employer, to whom reference may be made in support of your application concerning your professional ability and performance at work. If this is your first job, one reference should be from your head teacher, lecturer or similar. Please ensure your referees are in a position to respond promptly as no appointment will be made without receipt of satisfactory references. For academic posts references will be requested prior to interview. Appointments will be offered subject to receipt of satisfactory references, unless advised otherwise.

Completed applications must be returned by the closing date shown on the job advertisement. We will only acknowledge receipt of completed applications where a stamped addressed envelope is sent to us for this purpose. If you have not been contacted within 3 weeks of the closing date, please assume that your application has been unsuccessful.

CANDIDATE NUMBER:

CURRENT EMPLOYMENT
Job Title:

Present Salary:

Duties:

Name & Address of Employer:
Postcode:
Date Appointed to this post:

Period of notice required/date able to start:

PREVIOUS POSTS HELD
Start with the most recent employer and detail any gaps not covered by paid employment.
Dates
From

To

Name of employer and nature of business

Position held/Duties & Responsibilities

Salary
Start

Finish

HIGHER EDUCATION & QUALIFICATIONS
Start with the highest qualification.
Dates
From

Institution Attended

Qualifications

Subject & Class

To

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CANDIDATE NUMBER:

CONSULTANCIES
Dates

Organisation

Duties

POSTGRADUATE STUDENT SUPERVISION
Number of postgraduate students supervised and fields of research

Degrees obtained/in progress

RESEARCH FUNDING OBTAINED
Within the last five years.

Dates
From
To

Funding Body

Title of Project/Funding (£) Secured

CANDIDATE NUMBER:

ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION
e.g. reasons for applying for this post and how you meet the selection criteria

Please continue overleaf
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CANDIDATE NUMBER:

ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION
Continued from overleaf

CANDIDATE NUMBER:

RIGHT TO WORK IN THE UK
Do you need a visa in order to work in the UK? YES/NO
If YES please give details if you already have a visa.
We may be able to issue a Certificate of Sponsorship for this appointment subject to the necessary criteria being met.

CRIMINAL RECORD
Do you have any unspent criminal convictions? YES/NO
If YES please give details.
Certain appointments will be subject to a report from the Criminal Records Bureau.

TERMINATION OF PREVIOUS EMPLOYMENT
Have you ever left a job for any reason other than resignation, termination due to ill health or the end of a fixed term contract? YES/NO
If YES please give details.

PREVIOUS ASSOCIATION WITH UNIVERSITY OF SUSSEX
Have you ever worked at, studied at or had any other association with the University of Sussex? YES/NO
If YES please tick box below
(a) worked

(b) studied

(c) other (please give details)

Equal opportunities monitoring form
The University of Sussex is committed to equality of opportunity and will consider applications solely on the basis of merit and the ability to do the job. The data collected here is used for Equal Opportunities Monitoring only and will be kept separately from your application form. It will assist the University to support and encourage underrepresented groups and promote diversity.
Any personal data collected here will be held securely and confidentially and only used by the University in accordance with the provisions set out in the Data Protection Act 1998.
Please complete the sections below by circling the categories or ticking the boxes where appropriate.
Date of Birth

Gender

Male

Female

Disability
Have you a disability that is covered by the Equalities Act 2010?

Yes

No

When answering this question please note that under the Equalities Act 2010 you are considered to be disabled if you have a mental or physical impairment which has a substantial and long term adverse effect upon your ability to carry out normal day to day activities.
If Yes what is your impairment? Please tick any of the following that apply:
Specific learning disability, eg dyslexia, dyspraxia General learning disability eg Downs syndrome

Cognitive impairment eg autistic spectrum disorder Long-standing illness or health condition eg cancer,
HIV, diabetes, chronic heart disease, epilepsy

Mental health condition eg depression, schizophrenia Physical impairment or mobility issues

Deaf / serious hearing impairment

Blind / serious visual impairment

Other type of disability not mentioned above

Please specify

Ethnic Background
Please note that ethnic background is not about nationality, place of birth or citizenship. It is about colour and broad ethnic grouping. People may belong to any of the groups listed below. Please tick any of these that apply.
White
White Britsh
White Irish
Other White background

Black or Black British
Caribbean
African
Other Black background

Asian or Asian British
Indian
Pakistani
Bangladeshi
Other Asian background

Mixed
White and Black Caribbean
White and Black African
White and Asian
Other Mixed background

Chinese or other ethnic group
Chinese
Other ethnic background
Country of Birth
Nationality

Postcode where you live now

8 Thank you for completing this section of the form which will be detached and kept separately from your job application form.