Job Application Form
Position applied for: Coordinator
About You:
Title
First Name
Second Name
Address
Telephone
Mobile
Email
Introductory Questions
1. Are there any restrictions on your right to legally work in the UK?
(Please note you will be asked to show your passport and/or your work visa if you are
successful)
Please select:
 No – I am a UK/EU/EEA citizen
 No – I have a UK work visa or immigration status that gives me the right to work
without restriction in the UK
 Yes – I have a work visa but there are some restrictions
 Yes – I do not currently have a UK work visa
2. Have you been convicted of any criminal offences (that aren’t ‘spent’
under the Rehabilitation of Offenders Act 1974) or are there criminal
charges pending?
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Please select:
 Yes
 No
If you have answered Yes to the above, please give more details:
_______________________________________
_______________________________________
Role Specific Questions
3. Do you have relevant experience for the role?
Please tick all that apply
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
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Experience of administration and office management
Experience of finance or budget administration
Supported the delivery of large multi-stakeholder initiatives / events
Used a variety of computer and digital platforms
Experience of using social media in a professional environment to support a
particular project or campaign, or organisational messaging
 Microsoft Office skills, with capability in Outlook, Word, PowerPoint and Excel.
4. Which industry sector is your most recent experience within?
Please select













Advertising
Broadcast Media
Banking and Finance
Consumer Goods
Education and Governance
Health Sector
Information Technology
Leisure and Travel
Manufacturing
Professional Services
Retail
Telecomms
TV/Film Production
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 None of the Above
5. Which range does your current salary fall within?
Please select
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
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Under £20,000
£20,000 - £22,000
£22,000 - £25,000
£25,000 – £28,000
£28,000 - £30,000
£30,000 - £35,000
£35,000 – £40,000
6. How long is the notice period with your current position? __________________
Many thanks for your application.
Please email your completed form, together with an up-to-date CV, to
creativediversitynetwork@outlook.com with ‘CDN Coordinator’ in the
subject line. Alternatively you may bring your form with you if you are
selected for interview.
Closing date: 15th June 2015
All information can be obtained in an alternative format as part of any
Accessibility needs or requirements. If you would like assistance on this
please email creativediversitynetwork@outlook.com or phone
0207 713 9859.
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Diversity Monitoring
We would really like to capture the demographic associated with our application
process and so we would appreciate a little more information about you. This
information will be used solely for monitoring purposes and will not be used in your
application process:
1. What is your ethnic/cultural group?
Please select one main and one sub category:
White
Mixed
British
British
English
English
Scottish
Scottish
Welsh
Welsh
Irish
White & Black Caribbean
Gypsy
White & Black African
Irish Traveller
White & Asian
Other white background
Other mixed background
Asian
Black
British
British
English
English
Scottish
Scottish
Welsh
Welsh
Indian
Caribbean
Pakistani
African
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Bangladeshi
Other Black background
Other Asian background
Chinese
Middle/Near Eastern
British
British
English
English
Scottish
Scottish
Welsh
Welsh
Chinese
Middle/Near Eastern
Other Chinese background
Other Middle/Near Eastern
background
Central or Eastern European
British
English
Scottish
Welsh
Central or Eastern European
Other Central or Eastern European background
Prefer not to say
2. Do you consider yourself to have a disability?
Please select one:
Yes
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No
Prefer not to say
If yes which of the following descriptions best describes your disability?
Please select all that apply:
Visual (not including wearing glasses or contact lenses)
Manual dexterity or coordination
Mobility
Mental health
Speech impairment
Learning disability
Hearing
Epilepsy
Facial Disfigurement
Respiratory condition
Progressive Condition
Other (please specify)
Prefer not to say
3.
What is your sexual orientation?
Bisexual
Gay man
Gay woman/lesbian
Heterosexual/straight
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Other
Prefer not to say
4. What is your Gender?
Male
Female
5. What is your age?
Under 20
20-29
30-39
40-49
50-59
60+
Prefer not to say
6. What is your religion or belief?
Atheist
Buddhist
Christian
Hindu
Jewish
Muslim
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Sikh
Other
None
Prefer not to say
Our use of this information: The personal information you provide will be held in accordance with the Data
Protection Act 1998 by the Creative Diversity Network membership and by its agents and subcontractors with whom
the Creative Diversity Network has a contract to provide recruitment and business administration services. The
information you provide will be treated in strictest confidence and only used for the purposes permitted by schedule
3 of the Data Protection Act, including statistical monitoring and assessing whether our recruitment practices are free
from illegal discrimination.
____________________________________________________________________________________________
FOR OFFICIAL USE ONLY
SUBMIT BUTTON
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