Application Pack
Community Development Officer
Advertised May 2015
Contents
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Job Advert
About the Bumblebee Conservation Trust
About the ‘Making a Buzz for the Coast’ Project
Job description
Person specification
Summary of terms and conditions of employment
Recruitment and selection process
Application Form
Equal Opportunities Form
Job Advert
A unique opportunity to join a successful and growing
conservation charity!
Community Development Officer
Salary £24,000 (pro rata)
We are looking for a Community Development Officer to fill a
part-time (17.5 hours per week) 1 year fixed-term post during
the development phase of ‘Making a Buzz for the Coast’ - an
ambitious natural heritage project focusing on Kent’s wild
pollinators, especially bumblebees and solitary bees.
For an application pack please visit
our website:
bumblebeeconservation.org/vacancies/
Bumblebee Conservation Trust
University of Stirling
Your role will be to engage and consult communities, schools, Stirling
colleges and other interested groups; test approaches and
FK9 4LA
play a lead role in developing the project’s activity plan and
Tel: 01786 467818
learning and participation policy; and assist on production of
admin@bumblebeeconservation.org
the Stage Two delivery phase application to the Heritage
Lottery Fund.
Charity numbers: 1115634; SC042830
You will be self-motivated and enthusiastic, with excellent
communication skills. You will have proven experience of
engaging and motivating people, and be comfortable
interacting with all levels of the community to build networks.
You will be able to use your initiative to solve problems and
effectively prioritise your workload.
You must be willing to travel throughout the project area
(Kent) and have access to your own vehicle.
Please refer to the job description and person specification
for more details of the role.
This is a part-time, fixed term position which will primarily be
based from home (hot desk options can also be considered).
To discuss the post informally, please
contact:
Sam Page, Conservation Officer
Tel. 07780 931 114
sam.page@bumblebeeconservation.org
Closing Date:
12 pm Thursday 21 May 2015
Interview date:
02 June in Ashford, Kent (TBC).
This post is subject to funding
by the Heritage Lottery Fund
(pending approval).
About the Bumblebee Conservation Trust
The Bumblebee Conservation Trust is a UK-based national charity (England & Wales 1115634,
Scotland SC042830) and a Company Limited by Guarantee (No. 05618710). The Trust was
established in May 2006 in response to ongoing declines in many bumblebee species, due primarily
to habitat loss through agricultural intensification. In the last 70 years two species have become
nationally extinct whilst populations of several others have crashed dramatically. Over one third of
social bumblebee species are now regarded as species of principal importance under the UK Post2010 Biodiversity Framework. Bumblebees are ‘keystone’ pollinators, integral to our natural
environment, and providing significant economic benefits through pollination of crops. We aim to help
bumblebees and the habitats that they depend on through conservation and education.
This is an exciting time to join the Bumblebee Conservation Trust as we move into the next phase of
our development following the launch of a new five year strategic plan. For more information about
our work, visit our website (http://bumblebeeconservation.org).
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About the ‘Making a Buzz for the Coast’ Project
Making a Buzz for the Coast is an exciting community focused project and call to action, designed to
engage and encourage local people living in Kent (and part of East Sussex) to do something positive
to help and protect our bumblebees and other pollinating insects. This exciting and ambitious project
will take place along the 300 miles of coastline, from Dartford to Rye, and will focus on communities
and land within 5km of the coast. The project will act as a flagship initiative within the new DEFRAled National Pollinator Strategy and will help to deliver Kent County Council’s ‘Plan Bee’ aimed at
mobilising the people of Kent to take action to help pollinators. Making a Buzz for the Coast will
also play an important role in delivering Biodiversity 2020 (England’s national strategy for wildlife and
ecosystems) in Kent through restoration of priority habitats, increased habitat connectivity and
safeguarding threatened species.
The project has been developed in partnership with several organisations including Kent Wildlife
Trust, RSPB, the Short-haired bumblebee project and Kent County Council and is made up of eight
work strands (see below) which share the common themes of community engagement and learning
and have skills for bees at their heart. The project will also involve a range of key stakeholders and
other partners including landowners, local authorities, schools, community organisations, local
industry, businesses, the Environment Agency and the Highways Agency. Making tangible
improvements to bee habitat and linking together areas of habitat is a key element of the project and
one of Bumblebee Conservation Trust’s key strategic and long term aims.
Why Kent?
Kent’s cultural and economic heritage is intrinsically linked to bees. With its rolling landscapes which
give rise to a long tradition of fruit production and horticulture, abundant orchards and flowering crops,
Kent is heavily reliant on bees and the pollination services they provide. Declines in wild pollinator
populations over recent decades have led to a pollination deficit which negatively impacts on yields as
well as fruit or seed quality. Furthermore, bees are fundamental to ecosystem functioning in a diverse
range of habitats and bee declines have been linked to decreases in floristic diversity and wider
biodiversity losses.
The Kent coast is a hotspot for rare bumblebees such as the shrill carder bee Bombus sylvarum (the
UK’s most threatened bumblebee), brown-banded carder bee Bombus humilis and moss carder bee
Bombus muscorum, (priority species under Section 41, NERC Act 2006) as well as several rare
solitary bees such as the sea aster mining bee Colletes halophilus. These species exist in small,
isolated and highly fragmented populations along the coast which leads to inbreeding and a reduction
in genetic diversity, making populations even more vulnerable. They also have specific habitat
requirements (e.g. forage and nesting preferences) and the coastal habitats with which they are
associated such as grazing marsh; vegetated shingle; saltmarsh; sea walls; chalk grasslands; and
brownfield sites are under threat from development pressures, agricultural intensification,
inappropriate management, neglect, climate change and coastal squeeze. One of the primary aims of
Making a Buzz for the Coast will be to safeguard these rare bee populations by creating and
restoring habitat in existing population centres and linking isolated populations through the creation of
flower-rich ‘stepping stones’ and habitat corridors along the coast.
Making a Buzz for the Coast has four aims:
1) To protect and enhance Kent’s wild pollinator populations, with particular focus on
bumblebees and solitary bees, to boost pollination services and conserve biodiversity.
2) To safeguard and strengthen rare bumblebee populations, linking isolated populations.
3) To provide habitat for the newly reintroduced short-haired bumblebee – unique to Kent.
4) To raise awareness about bumblebees and other pollinators, the benefits they provide and
what can be done to help them, inspiring individual action.
These four aims will be achieved through the delivery of 8 work themes, shown here:
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Work strands – summary
1. Practical Conservation and habitat works: This work strand will build on the success and
experience of the pioneering Short-haired Bumblebee Project which has been taking forward the
reintroduction of this extinct species in the Dungeness area. Habitat creation through Making a
Buzz for the Coast across East and North Kent will benefit many species of bumblebee and
other pollinators and will also provide vital habitat for this bumblebee – thus helping to guarantee
its future survival.
2. Through BEE-Roads, roadside verges with potential for floristic improvement for bees will be
identified and targeted for sensitive management in partnership with Highways Agencies and Kent
Wildlife Trust’s Roadside Nature Reserves scheme.
3. Landowner engagement - working with farmers, fruit producers, holiday parks, parish councils
and large estate owners, we will help to restore and create bee-friendly habitat. Specialist land
management advice and management plans will be followed up with ongoing support. Targeted
landowner events such as workshops and farm days on best practice sites will be integral to
engaging landowners and equipping them with the skills to restore and create habitats for bees.
Conservation volunteer task groups will provide practical hands-on help on the ground. Advice
and assistance will be sought from other local initiatives, such as the recently launched
Coronation Meadows project, to help coordinate the supply and harvest of local wildflowers
including key forage plants for rare bees and identifying green hay donor sites.
4. Skills for Bees – Volunteering and skills development are key components of Making a Buzz for
the Coast. Volunteers and trainees will be recruited from across the community in each of the
core delivery zones and will be trained and supported to get involved in a range of activities such
as practical conservation tasks, surveys, leading guided walks, helping at community events,
giving talks and training others to deliver events.
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5. BeeWalk - Habitat and bee surveys will be an essential part of the project to help us gather
baseline data, monitor bee populations and evaluate the success of habitat creation and
restoration projects. BeeWalk will monitor bumblebee population densities along the Kent coast.
The presence of several confusing rare bee species in Kent can make it difficult to distinguish rare
bees from some of the more common species without adequate training. This makes it difficult to
get reliable data to properly monitor populations. With support from HLF, we will recruit and train
local volunteers to undertake regular bee surveys as part of BBCTs national recording scheme
Beewalk. Volunteers will attend a staged bee ID training programme (from beginners to
advanced) and receive ongoing support through local survey groups and a mentoring scheme
whereby expert volunteers will accompany newly trained volunteers on their surveys and lead
guided walks so new volunteers can practice their skills and build confidence in identifying difficult
species. We will also devise a system to help with verification of records. The scheme will then
be properly evaluated with a view to rolling it out to other regions with similarly confusing and
challenging species.
6. Have you seen this bee: This second monitoring project will teach local communities how to
identify the Shrill carder bee: a rare and characteristic species which can be spotted by its shrill
buzz and distinctive colour pattern. People will be encouraged to take photos and submit their
records to BBCT, so that we can get a better idea of the distribution of this vulnerable species and
track any population movements.
7. Buzzing Communities: This work strand will engage local communities in learning about the rare
and special bees that are found on Kent’s coast and will raise awareness about the importance of
bees and pollination services to Kent’s biodiversity, cultural heritage and local economy. A series
of guided walks, talks, bee identification training and other events (many led by volunteers) aimed
at local communities, schools, families and visitors to the Kent coast will take place throughout the
life of the project. Information and interpretation boards will be installed at habitat restoration sites
with public access to increase understanding about bees and what they need.
8. Buzzing Gardens is a vibrant gardening project aimed at helping schools, community groups and
local businesses and individuals to do bee-friendly gardening and enter an annual Garden with
Best Buzz competition in partnership with Kent Wildlife Trust (KWT), which will culminate in an
exciting Town or Village with the Best Buzz competition in Year 3 and build on learning from
KWT’s ‘Painting the Town Green’ Big Lottery project.
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Job Description
Job Title: Community Development Officer
Reporting to: Project Development Manager
Responsible for: Volunteers
Hours: This is a part-time (17.5 hours, 2.5 days a week) fixed term position and will be based in the
project area (Kent coast) / working from home.
Job purpose:
 To engage with communities, schools, colleges and other interested groups to inform the
community involvement aspects of Making a Buzz for the Coast - an ambitious natural
heritage project focusing on Kent’s wild pollinator populations especially bumblebees and
solitary bees.
 To assist in the development of the project’s activity plan, and learning and participation
policy.
 To work with the CEO, fundraising consultant and other staff on the production of BBCT’s
Stage Two application to the Heritage Lottery Fund.
Main responsibilities:
Project Development
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To work closely with the Buzz Project Development Manager and project partners to
develop engagement, training and volunteering opportunities across the project.
To play a lead role in developing the activity plan for Making a Buzz for the Coast.
To identify and plan volunteer and trainee opportunities across the project, including work
strand one (Habitat Works and Practical Conservation).
To develop a volunteer recruitment and retention strategy for the project and to identify, sign
up and support “Super Volunteers” to act as project ambassadors.
To develop opportunities for engagement and learning in work strand four (Skills for Bees),
which includes organising and running taster events; approaching schools, colleges and
community groups; and assisting in the development of a learning and participation policy.
To coordinate activities under work strand five (BeeWalk Rare Species) and test approaches
to training and supporting volunteers to identify and survey bumblebees (including rare
species) as part of an enhanced bumblebee recording scheme.
To undertake community consultation exercises to gauge interest, test approaches and
ideas as part of work strand six (Have you seen this Bee?); with particular focus on
identifying events, talks, workshops and shows for promoting this initiative.
As part of work strand seven (Buzzing Communities), to identify and sign up community
groups, societies, and schools in the project; and consult local communities to inform
activities, including competitions and roadshow.
To identify and scope out the types of materials needed to support community engagement
across the project.
General
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To build on learning from the Trust’s highly successful Bees for Everyone project but
focusing on Kent’s local needs, interests and opportunities.
To carry out your duties with regard to BBCT’s policies and procedures including health and
safety and fundraising regulations
Contribute to the overall outputs of the BBCT team and carry out duties with due regard to
the well-being and safety of others at all times.
Undertake any other duties commensurate with the nature of the post as deemed
appropriate and by agreement with the CEO.
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Person Specification
Essential
Desirable
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Experience of community engagement and a
proven record of engaging and motivating
people.
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Knowledge of bumblebee ecology,
conservation and bee-friendly
gardening.
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Experience of organising and delivering talks
and community events.
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Bumblebee identification skills.
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Experience of working with volunteers.
Experience of carrying out community
consultation.
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Excellent written and oral communication
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skills and an ability to communicate effectively
with a wide range of audiences.
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Good presentation and IT skills, including
social media.
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Active interest in bumblebees and pollinator
conservation, and a desire to learn about
bumblebee ecology and identification.
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Ability to think creatively and use own
initiative.
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Well organised, with excellent skills in
planning and prioritisation.
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Willingness to travel throughout the project
area.
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Full clean driving licence and access to own
car.
Knowledge of good practice in
volunteering, learning and participation.
Experience of developing projects
and/or activity and training programmes.
Experience of working with partner
organisations.
Relevant qualification (e.g.
ecology/conservation, community
development)
This post is subject to funding by the Heritage Lottery Fund (pending approval).
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Summary of terms and conditions of employment
Terms and conditions: This is a part-time, fixed term (1 year) post.
Salary: £24,000 per annum/pro rata
Pension: This fixed term post is eligible for the BBCT pension scheme
Location: This role involves travel throughout the project delivery area (Kent) and will be home-based
(although hot desk options can be considered).
Hours of work: The post holder will be employed part-time for 17.5 hours per week. Some
occasional evening/weekend work may be required and a system of flexitime is in place to
compensate this.
Annual leave: Annual entitlement of 35 days (on a pro rata basis for part-time staff) inclusive of
Bank/Public Holidays.
Policies and procedures: We have policies designed to ensure the safety and well-being of both
workers and volunteers e.g. health and safety, lone working.
Recruitment and Selection Process
The Bumblebee Conservation Trust is an Equal Opportunities employer. This means that when
carrying out our work and in the employment of staff to undertake this work, we will seek to ensure
equality of treatment for all persons regardless of ethnicity, gender, age, marital status, disability,
religion, sexual orientation, or economic status.
Pre-employment checks:
We will require a minimum of two appropriate references and will check original documents proving
your qualifications, identity, and right to live and work in the UK before you can start work with us.
You will be asked to provide details of any unspent criminal convictions.
References:
Referees should be your present and last employer. They should have had either managerial or
supervisory responsibility for your work, and not be colleagues, subordinates or friends. Where
appropriate (i.e. when this is your first employment), a tutor’s reference and a personal reference or
similar will be acceptable.
Referees will be provided with a copy of the job description and person specification for the vacancy.
BBCT will only approach your referees once an offer of employment has been made.
How we use your personal information:
The information which we gather from you during the recruitment and selection process is retained
and processed in accordance with the provisions set out by the Data Protection Act 1998 (DPA).
Please note that by submitting an application for employment, you are also agreeing to the
Bumblebee Conservation Trust processing such information as may be necessary to assess your
application, provided that proper regard is had to the data protection principles in force.
If your application is successful, the information you provide will be retained and will form part of your
personnel file. If you are not offered work with the Bumblebee Conservation Trust, all documentation
related to your application will normally be confidentially destroyed after a period of six months.
How to apply:
If you are interested in joining us, please complete the application form below and return by email to
admin@bumblebeeconservation.org no later than 12 pm on Thursday 21 May 2015.
In order to ensure that all applicants are assessed equally and fairly, applications will only be
accepted on the form provided. Please do not send CVs.
Interviews are expected to take place on 01/02 June 2015 (TBC).
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Application Form
PRIVATE AND CONFIDENTIAL
APPLICATION FOR THE POST OF:
COMMUNITY DEVELOPMENT OFFICER
CLOSING DATE:
12 pm on Thursday 21 May 2015
APPLICANT INFORMATION
TITLE:
SURNAME:
INSTRUCTIONS FOR COMPLETION:
 Complete using black ink (block
capitals) or typescript (normal case)
 Answer all questions
 Do not attach a C.V.
PLEASE RETURN COMPLETED FORM TO:
Recruitment, Bumblebee Conservation Trust
University of Stirling, Stirling, FK9 4LA
admin@bumblebeeconservation.org
FORENAME(S):
ADDRESS (including postcode):
DAYTIME TELEPHONE NUMBER:
EVENING TELEPHONE NUMBER:
EMAIL ADDRESS:
CAN YOU PROVIDE PROOF OF YOUR RIGHT TO LIVE AND WORK IN THE UK?
Yes
No
(please tick/double click to select)
DO YOU HOLD A FULL CLEAN DRIVING LICENCE?
Yes
No
(please tick/double click to
select)
DO YOU HAVE ACCESS TO A CAR TO USE AT WORK?
Yes
No
(please tick/double click to
select)
IF YOU HAVE A DISABILITY WILL YOU REQUIRE ANY REASONABLE ADJUSTMENTS MADE TO
ENABLE YOU TO ATTEND AN INTERVIEW?
Yes
N/A
(please tick/double click to select)
If yes please provide details:
HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE (DECLARATION SUBJECT TO
THE REHABILITATION OF OFFENDERS ACT 1974)?
Yes
No
(please tick/double click to select)
If yes please provide details:
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EMPLOYMENT HISTORY
PRESENT OR MOST RECENT EMPLOYMENT
DATE FROM:
DATE TO:
JOB TITLE:
COMPANY NAME:
DUTIES & RESPONSIBILITIES:
SALARY:
FULL TIME
PART TIME
(please tick/double click to select)
REASON FOR LEAVING:
IF STILL EMPLOYED PLEASE STATE NOTICE PERIOD REQUIRED:
PREVIOUS EMPLOYMENT Please continue on a separate sheet if necessary
DATE FROM:
DATE TO:
JOB TITLE:
COMPANY NAME:
DUTIES & RESPONSIBILITIES:
SALARY:
FULL TIME
PART TIME
(please tick/double click to select)
REASON FOR LEAVING:
DATE FROM:
DATE TO:
JOB TITLE:
COMPANY NAME:
DUTIES & RESPONSIBILITIES:
SALARY:
FULL TIME
PART TIME
(please tick/double click to select)
REASON FOR LEAVING:
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DATE FROM:
DATE TO:
JOB TITLE:
COMPANY NAME:
DUTIES & RESPONSIBILITIES:
SALARY:
FULL TIME
PART TIME
(please tick/double click to select)
REASON FOR LEAVING:
DATE FROM:
DATE TO:
JOB TITLE:
COMPANY NAME:
DUTIES & RESPONSIBILITIES:
SALARY:
FULL TIME
PART TIME
(please tick/double click to select)
REASON FOR LEAVING:
DATE FROM:
DATE TO:
JOB TITLE:
COMPANY NAME:
DUTIES & RESPONSIBILITIES:
SALARY:
FULL TIME
PART TIME
(please tick/double click to select)
REASON FOR LEAVING:
EDUCATION
DATE FROM:
DATE TO:
SCHOOL/COLLEGE/UNIVERSITY:
QUALIFICATIONS Please state level and grade obtained
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DATE FROM:
DATE TO:
SCHOOL/COLLEGE/UNIVERSITY:
QUALIFICATIONS Please state level and grade obtained
DATE FROM:
DATE TO:
SCHOOL/COLLEGE/UNIVERSITY:
QUALIFICATIONS Please state level and grade obtained
TRAINING & DEVELOPMENT
DATE FROM:
DATE TO:
TRAINING INSTITUTE/AWARDING BODY:
QUALIFICATIONS Please state level and grade obtained
DATE FROM:
DATE TO:
TRAINING INSTITUTE/AWARDING BODY:
QUALIFICATIONS Please state level and grade obtained
DATE FROM:
DATE TO:
TRAINING INSTITUTE/AWARDING BODY:
QUALIFICATIONS Please state level and grade obtained
MEMBERSHIP OF PROFESSIONAL BODIES (if applicable)
NAME OF INSTITUTE/PROFESSIONAL BODY:
MEMBERSHIP TYPE:
NAME OF INSTITUTE/PROFESSIONAL BODY:
MEMBERSHIP TYPE:
NAME OF INSTITUTE/PROFESSIONAL BODY:
MEMBERSHIP TYPE:
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PERSONAL STATEMENT
Detail how your knowledge, skills and experience will enable you to fulfil the requirements of
the post. Please refer to the job description and person specification when completing this
section. You can also include details of any voluntary activities or interests, as well as any
other relevant information you would like us to consider in support of your application.
Please do not exceed 2 sides of A4 in length.
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REFERENCES
Please give details of TWO people who can confirm your suitability for this role. This should include
your present/most recent employer and they must not be related to you in any personal capacity (e.g.
friends or family members). We will only approach referees if you are offered the post.
TITLE:
SURNAME:
FORENAME(S):
JOB TITLE:
ADDRESS (including postcode):
DAYTIME TELEPHONE NUMBER:
EVENING TELEPHONE NUMBER:
EMAIL ADDRESS:
CAPACITY IN WHICH KNOWN TO YOU:
TITLE:
SURNAME:
FORENAME(S):
JOB TITLE:
ADDRESS (including postcode):
DAYTIME TELEPHONE NUMBER:
EVENING TELEPHONE NUMBER:
EMAIL ADDRESS:
CAPACITY IN WHICH KNOWN TO YOU:
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DECLARATION
 I confirm that, to the best of my knowledge, the information on this form is correct.
 I accept that if any of the enclosed information is found to be untrue after my appointment, I
may be liable for dismissal without notice.
 I authorise you to contact the references listed on this form and make any other checks
deemed appropriate once an offer of employment is made.
 I am aware that the information given will be processed and stored by the Bumblebee
Conservation Trust in accordance with the Data Protection Act 1998 and I have the right to
view any personal data held about me (upon written request and payment of an administration
fee).
NAME (PLEASE PRINT):
SIGNATURE:
DATE:
Please also complete and return the separate Equal Opportunities Monitoring Form
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Equal Opportunities Monitoring Form
PRIVATE AND CONFIDENTIAL
The Bumblebee Conservation Trust operates an Equal Opportunities Policy and no person will be
discriminated against whilst seeking employment or during such employment with the Trust on the
grounds of any protected characteristics such as age, disability, ethnic origin, gender, marital status,
political allegiance, race, religious belief, sexual orientation, responsibility for dependants, or
unrelated spent criminal convictions.
The following information will be kept strictly confidential and stored separately from the application
form before short-listing takes place. It will not form any part of the recruitment process or decision to
appoint and will be used to provide data for monitoring purposes only.
You may choose to leave any or all questions unanswered.
POST APPLIED FOR:
FULL NAME:
AGE:
DATE OF BIRTH:
GENDER
(Please circle/cross out as
appropriate):
MALE/FEMALE/
TRANSGENDER/
OTHER
(Please
specify)________________
MARITAL STATUS (Please
circle/cross out as appropriate):
MARRIED/CIVIL PARTNERSHIP/SINGLE/DIVORCED/LIVING
WITH PARTNER/OTHER
DO YOU HAVE
RESPONSIBILITY FOR
DEPENDANTS (e.g. children,
elderly, or any other person for
whom you are the main carer)?
IS THIS THE
SAME GENDER
YOU WERE
ASSIGNED AT
BIRTH?
Yes
No
(please tick/double
click to select)
CHILDREN
ELDERLY
OTHER
NOT APPLICABLE
DISABILITY
Do you consider yourself to
have a physical and/or mental
impairment as defined by the
Equality Act 2010/ Disability
Discrimination Act 1995 (NI)?
Yes
ETHNIC ORIGIN
How would you describe your
identity?
WHITE:
BRITISH
ENGLISH
IRISH
SCOTTISH
WELSH
OTHER (PLEASE SPECIFY): _____________________________
BBCT Application Pack
No
(please tick/double click to select)
Please give details if you wish:
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MIXED:
WHITE AND BLACK CARIBBEAN
WHITE AND BLACK AFRICAN
WHITE AND ASIAN
OTHER (PLEASE SPECIFY): _____________________________
ASIAN, ASIAN BRITISH, ASIAN ENGLISH, ASIAN SCOTTISH
ASIAN IRISH OR ASIAN WELSH (Delete as applicable):
INDIAN
PAKISTANI
BANGLADESHI
OTHER (PLEASE SPECIFY): _____________________________
BLACK, BLACK BRITISH, BLACK ENGLISH, BLACK
SCOTTISH, BLACK IRISH, BLACK WELSH (Delete as
applicable):
CARIBBEAN
AFRICAN
OTHER (PLEASE SPECIFY): _____________________________
CHINESE, CHINESE BRITISH, CHINESE ENGLISH, CHINESE
SCOTTISH, CHINESE IRISH, CHINESE WELSH (Delete as
applicable):
CHINESE
OTHER (PLEASE SPECIFY): _____________________________
OTHER ETHNIC ORIGIN:
(PLEASE SPECIFY): ____________________________________
RELIGION/CULTURAL
BACKGROUND
NONE
CHRISTIAN
BUDDHIST
HINDU
JEWISH
MUSLIM
SIKH
OTHER (PLEASE SPECIFY): _____________________________
WHERE DID YOU SEE THIS
POST ADVERTISED?
SIGNATURE:
DATE:
Thank you for taking the time to complete this form.
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