Welsh Crucible 2014 Application Form Please submit your completed form to welshcrucible@cf.ac.uk by midnight GMT on March 9th 2014. We regret that late submissions cannot be accepted. Please return the form as a Microsoft Word document (and not as a pdf). Please contact welshcrucible@cf.ac.uk if you have any queries about any aspects of the selection process. 1 Eligibility ☐ I confirm that I have a minimum of three years’ postdoctoral research experience (or equivalent). Welsh Crucible Labs take place in Cardiff on May 29th and 30th, in Bangor on June 26th and 27th, and in Swansea on July 24th and 25th 2014. You must commit to attending all three residential workshops. By ticking the boxes you are confirming your attendance at all of the following Labs: ☐ May 29th and 30th ☐ June 26th and 27th ☐ July 24th and 25th 2 Applicant Details Title: Click here to enter text. First Name: Click here to enter text. Surname: Click here to enter text. What is your main academic discipline? 3 Contact Details Organisation Name Postal Address Postcode Telephone No. Alternative Telephone No. Email Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. -1- Click here to enter text. 4 About You Guidance for Applicants Welsh Crucible is for talented early- to mid- career researchers who can demonstrate o excellence in their research; o interest and experience in interdisciplinary research. Successful applicants will be able to demonstrate a breadth of experience, or interest, particularly with respect to range of disciplines. o creative and innovative thinking; o an understanding of and commitment to Welsh Crucible’s mission; o interests outside their basic areas of research. Successful applicants will be able to demonstrate both an interest in applying their research as well as work-related interests beyond research; and o excellent communication skills. Please consider these criteria when completing the following sections, as they will be used to select the successful applicants. The form will not allow responses in excess of the specified character limits. These limits include spaces. (i) Please tell us briefly about yourself and why you believe that you should be invited to participate in Welsh Crucible. Please refer to the criteria specified above. (1500 characters maximum) (ii) Please demonstrate how you meet the criterion of excellence in research, with reference to your main publications (please list up to 6 of your best publications), research income, and your strongest indicators of esteem (e.g. invitations to present your work). (3500 characters maximum) (iii) Please provide details of your work-focused activities outside research – such as public engagement activities or involvement with learned societies or subject groups. (450 characters maximum) -2- (iv) Please detail any relevant interdisciplinary collaborations you have been involved in. What type of collaborations would you be interested in developing and what type of researcher would you like to meet if you were to participate in Welsh Crucible? (450 characters maximum) (v) Please give an example of how you have demonstrated creativity and/or innovation in your work or through your outside interests (450 characters maximum). (vi) What do you expect to be doing professionally in 10 years’ time and why? How might participating in Welsh Crucible affect this? (1500 characters maximum) 5 Optional Details Where did you hear about Welsh Crucible? Click here to enter text. -3- 6 Equal Opportunities Monitoring Welsh Crucible aims to support the development of highly promising researchers working in Wales and is committed to providing equality of opportunity irrespective of applicants’ sex; religious belief; political opinion; race; age; sexual orientation; or whether they are disabled; or whether they are married or are in a civil partnership; or whether they have undergone, are undergoing or intend to undergo gender reassignment. In support of our commitment to equality of opportunity we monitor applicants according to the categories listed below. Completion of this form (in all or part) is voluntary, but your assistance is appreciated. The information you give will not be used for selection purposes. Age (as at 9th March 2014): ☐ ☐ ☐ ☐ ☐ ☐ 16-24 25-34 35-44 45-54 55-64 65+ Gender ☐ ☐ Female Transgender ☐ ☐ Male Prefer not to say Disability Do you consider yourself to have a disability? ☐ Yes ☐ No If ‘yes’ please specify: Click here to enter text. Sexual Orientation ☐ ☐ ☐ Bisexual Heterosexual Prefer not to say ☐ ☐ Gay Lesbian Religion or Belief ☐Agnostic ☐Buddhism ☐Christianity -4- ☐Hinduism ☐Judaism ☐Other ☐Islam ☐Sikhism ☐Jainism ☐No religion ☐Prefer not to say Ethnic Group (categories based on 2001 census and listed alphabetically) Asian, Asian British, Asian English, Asian Scottish, Asian Welsh ☐Bangladeshi ☐Indian ☐Pakistani ☐Chinese ☐Any other Asian background (specify below if you wish) Click here to enter text. Black, Black British, Black English, Black Scottish, Black Welsh ☐African ☐Caribbean ☐Any other Black background (specify below if you wish) Click here to enter text. Mixed ☐White & Asian ☐White and Black Caribbean ☐White & Chinese below if you wish) Click here to enter text. ☐White & Black African ☐Any other Mixed background (specify White ☐British ☐English ☐Irish ☐Scottish ☐Welsh ☐Any other White background (specify below if you wish) ☐Prefer not to say Nationality Click here to enter text. -5- 7 Data Protection Information provided by you on this application form may be copied for use during the assessment process. Once the assessment process is complete, the data will be stored for six months and then destroyed. If you are a successful candidate relevant information may be taken from this form and used as part of your personal Welsh Crucible record. If you are unsuccessful and work in a Welsh higher education institution, your HEI will contact you to explore how it can provide you with further support and development in this area. Cardiff University, on behalf of Welsh Crucible, is the data controller and all information will be treated as confidential (Data Protection Act, 1998). ☐ I consent to the use of information in my form in this way. -6-