candidate reference (office use only) _______________
Application form
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Please fill in your answers electronically or print out this form and complete it in black
ink
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Please ensure that you answer all questions as fully as possible and that you sign the
form;
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Applications will be acknowledged by email only so please ensure you provide a current
contact email address
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Completed application forms must reach science made simple, c/o School of Physics
and Astronomy, 14-17 The Parade, Cardiff CF24 3AA by 3pm on MONDAY 25th JANUARY
2016. Application forms should be emailed to info@sciencemadesimple.co.uk by this
deadline and you will receive a confirmation within 24 hours that we have received it.
1. Personal details
Full name:
Current contact address:
Postcode:
Telephone number (including area code):
Mobile number:
Email address:
Nationality:
National Insurance number:
Driving Licence number:
Do you consider that you have a disability?
Yes:
No:
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If so, please state any requirements you would need to assist you at the interview:
2. Educational qualifications
Please provide details of your post-primary education:
Name of school/university and town
Dates attended
GCE A level or equivalent qualifications:
Examining board
Year of exam
Level
Subject
Grade
First degree and/or postgraduate qualifications:
University/college
Dates of
attendance
Grade
Awarded *
Subject
* if you are still studying state when you expect to complete your degree.
Professional qualifications:
Title of qualification
Membership of professional bodies:
Professional body
Date Awarded
Type of membership
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3. Employment history
Please list all your employment/self-employment (and unemployment) since you finished
education starting with the present/ most recent position
From
Month
Year
Until
Month
Employer
Job title
Main responsibilities
Year
May a reference be requested from your present/most recent employer?
Yes:
No:
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4. Other information
Have you ever been convicted of any criminal offence or been subject to a caution?
Yes:
No:
Are any criminal proceedings due against you?
Yes:
No:
If you answered “Yes” to either question please give full details below:
Bearing in mind that you will be dealing with the public and school students, do you have
(or have you had) any medical condition that may affect your ability to perform the duties
of the post applied for?
Yes:
No:
If yes, please give details:
If appointed, how much notice would you require before taking up appointment?
If appointed, are you available to travel to Ireland on a tour with one of our presenters on
27th February to the 5th March 2015?
Do you have any hobbies/ leisure activities relevant to the position? If so, please detail
below:
Do you have a full current driving licence which allows you to drive in the UK?
Yes:
No:
If you are not a British citizen, do you have a work visa or permission to work in the UK?
Yes:
No:
N/A:
5. References
Please give the name, address and positions of two responsible persons (not related to you)
who are well acquainted with you and willing to answer questions about your character,
experience and qualifications for appointment.
Reference One:
Name:
Email:
Position:
Address:
Telephone no.
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Reference Two:
Telephone no.
Name:
Email:
Address:
Position:
6. Experience and qualities
In this section please state how you meet the requirements of the job, giving examples as
appropriate.
Please describe any experience you have in science or engineering communication
Please explain why you personally believe science and engineering communication is
important
Do you have any personal restrictions that would limit you from travelling away from
Cardiff for periods of a week at a time? If so please give details here.
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Please outline any other experience you have in working with young people in formal or
informal education, or other settings.
Please provide evidence of your organisational, administrative or project management
skills.
Please specify your level of experience in the following IT tasks:
No Experience
Some
experience
Advanced
User
Word processing software
Powerpoint
Email programmes
Financial spreadsheets
Web publishing software
Mac computers
Social media
You Tube
Video editing software
Newsletter/publishing software
Any other? Please state
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Please give an example of when you have worked on your own initiative and an example of
when you have worked as part of a team:
What excites you most about this job and how do you relate to the mission of science made
simple (our mission can be found on our website)
Please outline a brief idea for a new science show of your own invention (continue on
another page if necessary – this can be a show that already exists providing it was your own
creation)
Title of show:
Who is the target audience?
Write a short descriptive paragraph that could be used for marketing purposes to sell the
show to potential customers (max 100 words)
Describe briefly the content covered
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What would the format, or the storyline, of the show be?
Describe in detail one of the demonstrations in the show. Include information on where you
would source props (or how you would make them), how the demonstration would show a certain
concept and an awareness of how you ensure the safety of the demonstration.
7. Declaration by applicant
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I confirm that the above information is correct. I understand that misleading statements may be
sufficient grounds for cancelling any agreements made.
Typed name:
Date:
If you are unsuccessful on this occasion are you happy for us to keep your application on
file for any future positions that may arise?
Yes:
No:
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