 Please complete in either typescript font size 12, or write clearly using black ink.
 Please ensure that you attach your CV.
 Please ensure that you attach your Political and Equality & Diversity Questionnaires.
APPLICANT INFORMATION
Position Applied for:
Surname
Civil Service Commissioners for Northern Ireland
First
Name
Title
Home Address
Home Phone No
Mobile
E-mail Address
National Insurance
Number
CONFLICTS OF INTEREST
Please give details of any personal, business, political or other interests, which your appointment
to the Northern Ireland Office could result in, or be perceived as, a conflict of interest. Please also
provide information on how you would address the issue should you be successful in your
application.
PERSONAL STATEMENT
The following page gives you the opportunity to give details of the qualities, skills and experience
you can bring to the position for which you are applying. You should refer to the person
specification in the candidate information pack before completing your statement.
Please note that you must restrict your statement to a maximum of one page.
ACCESS OR OTHER REQUIREMENTS
If called for interview, will you require any special assistance? If so, please specify below.
Please also indicate if there are any dates in December 2015/January 2016 that you will be
unavailable to attend if called for interview.
DECLARATION AND SIGNATURE
In line with the Northern Ireland Office’s principles of openness and transparency some of the
application information may be made public on appointment. This may include a brief summary of
your career/experience; the length of appointment; whether it is paid or not and, if so, the amount; a
list of other appointments held with any related remuneration received; and your response to the
political activity question.
I confirm that, to the best of my knowledge, the information I have given is correct and I am willing
to commit the necessary time to the Civil Service Commissioners for Northern Ireland.
Signature:
Date:
(Please type your full name if returning electronically)
APPLICATION PROCESS
E-mail your completed application form
accompanied by your CV and a copy of your Address:
Political and Equality & Diversity Questionnaires
to: cscni2016@nio.x.gsi.gov.uk
If do not receive a confirmation of the safe
receipt of your application within 48 hours
(please allow extra time if sent at the weekend) Tel:
then please call us to check we have received it.
Competition Co-ordinator,
Northern Ireland Office, Room
122, Stormont House Annex,
Stormont House, Belfast, BT4
3SH
028 90765497
Please return the completed form by email or to the address above to be received no later than
Friday 6th November 2015. Late applications will not be accepted.
EQUALITY OF OPPORTUNITY
The Northern Ireland Office is committed to the principle of public appointments based on merit
with independent assessment, openness and transparency of process. The Northern Ireland
Office is also committed to equality of opportunity and as women; people from ethnic backgrounds
and people with disabilities are currently underrepresented as Civil Service Commissioners
applications from these groups would be particularly welcome.
GUARANTEED INTERVIEW SCHEME
We guarantee to interview anyone with a disability whose application meets the minimum
criteria for the post. By ‘minimum’ criteria we mean that you must provide us with evidence in
your application summary form which demonstrates to the selection panel that you generally
meet the level of competence required for any of the qualifications, skills or experience as set
out in the candidate’s information pack for the post).
What do we mean by disability?
The Disability Discrimination Act 1995 defines a disabled person as someone who has a
physical or mental impairment which has a substantial and adverse long-term effect on his or
ability to carry out normal day-to-day activities.
How do I apply?
If you want to apply under the Guaranteed Interview Scheme simply complete the declaration
below and send it in with your application.
We will try to provide access, equipment or other practical support to ensure that if you have a
disability you can compete on equal terms with non-disabled people.
DECLARATION
I consider myself to have a disability as defined above and I would like to apply under the
Guaranteed Interview Scheme.
I require the following special arrangements to be made for me to be able to attend an interview:
…………………………………………………………………………………………………
…………………………………………………………………………………………………
Name: …………………………………..………
Date: ………………………..….….
Signature*: …………………………………………………………………………….…….
Vacancy Job Title: ………………………………………………………..........................
*There is no need for a signature if you are submitting the form electronically.
Please return the completed form with your application.
ANY FALSE DECLARATION OF DISABILITY TO OBTAIN AN INTERVIEW WILL
SUBSEQUENTLY INVALIDATE ANY OFFER OF A POST