Student Ambassador Application Form 2009-2010
Section 1 - Information about you
Role applying for:
 Student Ambassador
First Name:
Surname:
Phone Number:
Mobile number:
Email:
Address:
Postcode:
Date of Birth:
Gender:
 Male
 Female
Course Currently Studying (Year)
Student ID Number
National Insurance Number
Section 2 – Experience (please list any relevant experience)
Job Title and Organisation
Dates Employed
Do you currently work, or have you ever, worked for
the University as any of the following?
If yes please give details:
Brief outline of job description
 Ambassador
 Mentor
 Student Associate
 Student Rep
Section 3- Application Questions
Being a Student Ambassador requires excellent communication. Please provide some examples of
your communication skills.
Please give an example of a time when you have solved a problem by working as part of a team
How would you promote Newcastle University to prospective students both locally and nationally?
Section 4 – Criminal Convictions/ Health
This information will only be used to assess applicant’s suitability for employment, in so far as it is relevant. Applicants will
be considered on merit and ability and will not be discriminated against unfairly.
Do you have any disabilities or medical conditions
 Yes
 No
Will you require a work permit to work in the UK?
 Yes
 No
If you are not a British or European Economic Area citizen you may need a work permit to be able to work in the UK.
Have you ever been convicted of any criminal offence?
 Yes
 No
Your attention is drawn to the fact that under the Rehabilitation of Offenders Act 1974 you may be entitled to answer ‘no’
to this question even if you have in the past been subject to criminal proceedings resulting in conviction(s). However,
certain types of employment are excluded under the Rehabilitation of Offenders Act 1974 (Exemptions Order 1975) from
the protection. This post requires a police clearance; additional guidelines can be obtained from human resources.
Please note:
A Criminal Record Bureau disclosure will be requested when a candidate is made an offer of employment and the position
requires police clearance
Section 5 - References
Name:
Name:
Position:
Position:
Address:
Address:
Telephone No:
Telephone No:
Email:
Email:
How long have you known this referee and in what
capacity?
How long have you known this referee and in what capacity?
Section 6 - Availability
Please state your availability for the Student Ambassador assessment sessions (tick box as appropriate)
20th October 2009 (Evening)
21st October 2009 (Afternoon)
21st October 2009( Evening)
Section 7 - Declaration
By submitting this form you are indicating your understanding and acceptance of the following provisions:

To the best of your knowledge the information you have given on this form is correct.

The provision of false information may result in disqualification or termination of your employment.

Under the Rehabilitation of Offenders Act 1974 failure to disclose any convictions may result in dismissal or disciplinary
action by the University.

Under legislation for the Protection of Children you will be asked to agree to a check being made through the Criminal
Records Bureau about the existence and content of a criminal record.

You consent to the processing of your data for the purpose of assessing your application.

You are available to work from October 09 to July 2010 and to attend compulsory training on 28th October 2009

Offers of employment will be subject to successful assessment, full CRB clearance and references.
Signed

Please return completed form to:
Date
Student Ambassador Applications
Student Recruitment Team
6 Kensington Terrace
Newcastle University
Newcastle upon Tyne, NE1 7RU
If you have any questions regarding the post or your application please contact George Hunt,
George.Hunt@ncl.ac.uk 0191 222 3484 or Iain Harris (HASS), Iain.Harris@ncl.ac.uk 0191 222 7144 or
Louise McCarthy (SAgE), Louise.McCarthy@ncl.ac.uk 0191 222 7687