zilongwang/ReadingBank huggingface dataset:
* Financial period counts from to March. * Please put your initials of each Part – A Sr. No Particulars Details 1 No. of trainees trained in the industry/on job training to trainees > 90 80 to 90 70 to 79 60 to 69 50 to 59 2 No. of instructors trained in the industry > 12 10 to 12 7 to 9 4 to 6 1 to 3 3 Financial contribution by the industry partner > Rs. 1.0 cr. Rs.0.75 cr to 1 cr Rs.0.50cr to Rs.0.75 cr Rs.0.25 cr to Rs.0.50cr < Rs.0.25cr. 4 No. of trainees placed in the industry of the industry partner > 90 80 to 90 70 to 79 60 to 69 50 to 59 5 Expenditure incurred towards up-gradation of facilities/ infrastructure > Rs. 2.00 cr. Rs.1.50 cr to Rs.2.00 cr. Rs. 1.0cr to Rs.1.50 cr Rs.0.50 cr to Rs.1.0 cr < Rs.0.50cr. F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 6 Revenue generation by IMC (Income from activities and Bank interest to be given separately) > Rs. 1.25 cr. Rs.1.00 cr to Rs.1.25 cr. Rs.0.75 cr to Rs.1.00 cr Rs.0.50 cr to Rs.0.75 cr < Rs.0.50cr. F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 7 Percentage of students pass out as compared to enrolled 100% 90 to 99% 80 to 89% 70 to 79% 60 to 69% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15
8 Percentage of pass out students placed in the industry > 95% 91 to 95% 86 to 90% 81 to 85% 75 to 80% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 9 Theory sessions conducted 100% 99 to 96% 91 to 95% 86 to 90% 81 to 85% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 10 How many campus interviews conducted in the last 3 years 15 and above 12 to 14 9 to 11 6 to 8 3 to 5 F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 11 How many industries/firms participated in the campus interview 15 and above 12 to 14 9 to 11 6 to 8 3 to 5 F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 12 No. of instructors sent for training in industry and other training institutes > 12 10 to 12 7 to 9 4 to 6 1 to 3 F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 13 No. of industrial visits arranged for trainees 10 and above visits 8 to 9 visits 6 to 7 visits 4 to 5 visits 2 to 3 visits F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15
14 Percentage increase in intake capacity More than 100% 80 to 100% 60 to 80% 40 to 60% 20 to 40% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 15 Percentage of enrolment as compared to number of 100% 95 to 99% 92 to 94% 85 to 89% Less than 84% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 16 Percentage dropout as compared to enrolment Zero dropout Upto 2.5% Upto 5% Upto 7.5% Upto 10% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 17 Percentage of students pass out as compared to enrolled 100% 90 to 99% 80 to 89% 70 to 79% 60 to 69% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 18 Percentage increase in placement of passed out students against previous year >100% 75 to 100% 50 to 74% 25 to 49% <25% F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 Sr. No. Details F.Y. 2012-13 F.Y. 2013-14 F.Y. 2014-15 19 Budget allocated for Skill development 20 Budget utilized for Skill Development 21 Total Number of youth skilled
aerodrome certification guidelines Evidences for key personnel Date of document Chart of the organization of the aerodrome operator Date of document Evidences for adequacy of financial resources (business plan, accounts) Date of document Actual version of the aeronautical information publication of the aerodrome (AIP) including Charts and Obstacles within the OLS Date of document Additional documents as outlined in the application form Date of documents Coordination documents with local ATC Date of documents Written agreements with stakeholders and other partners Date of documents The Accountable manager of the aerodrome operator applies for a certificate under article 8a para. 2 of regulation (EC) 216/2008. Date of application Signature of the accountable manager
Volunteer Application form Title: First Name: Last Name: Address: Post Code: Telephone Home: Work: Mobile: Date of birth: Email address: Car driver: Y/N Have own car: Y/N Status (Please Tick) Unemployed Student Retired Working Part-Time Working Full-Time Other (please state) How much time do you have available for volunteering? (eg. 2 hours per week or 5 hours per month.): Please state available days of the week, and morning or afternoon: Please ‘X’ the volunteer role(s) in which you are interested. Administration Attendance Allowance advice Charity Shops Computer Skills/IT Driving (own car) Pop-In/Lunch Clubs Leaflet distribution Low-level Advocacy Odd Jobs Events & Fundraising Winter Warmth Advice Befriending Street fundraising collections Collection tin distributor to shops etc E-bay If you are responding to a specific role please the name of the role: Any skills, interests, hobbies, previous experience you can offer to Age UK: Experience with any of the following: Energy Company, Usage Installations, Efficiency Advice and Environmental Issues Experience with Vulnerable people How did you find out about voluntary work with us? (Please ‘X’ any below)
comment on behalf of their organisation. Please do not give friends or relatives as references. Name: Name: Company/ Organisation: Company/ Organisation: Position: Position: Address: Address: Telephone Number: Telephone Number: Address: Email Address: May we contact this referee without consulting you? Yes / No May we contact this referee without consulting you? Yes / No Employment History Present/last: Dates of employment: Address: Starting salary: Final salary: Type of business: Position held: Describe the work undertaken Reason for leaving Please give details of previous employment
Tick (√) the most appropriate answer (one only) with relevant support document 11.3 Has the Organization/Unit taken any major safety initiative last year to improve safety culture like behaviour based safety, zero tolerance initiative, ergonomics interventions etc What type of initiative taken? Does it have a systematic approach, involvement of various levels of employees, inclusion of contract workers, monitoring mechanism for effectiveness of implementation? 11.4 Mention the details of Safety awards/recognitions received by your Organization/Unit Whether any Safety Awards received from State/National Govt, Industry Association, International bodies. 12. Occupational Health Management System 10 Marks 12.1 Does your organization/ unit have an Occupational Health (OH) Surveillance Program? If yes, what are the components of OH surveillance programs that are carried out Whether the organization has any such programme. If so, how comprehensive is the same. Is it a well laid out and structured OH surveillance program? Does it medical fitness, Health surveillance, Biological monitoring (if applicable) and Industrial hygiene survey? Are Action plans prepared and implemented? 12.2 Give the percentage compliance of medical examination and periodic Medical examination (PME) of employees and contract workers for last financial years in your organization/unit. Pre - employment Medical (PEM) Fitness Compliance Assessment is on the basis of coverage of Pre-employment medical (PEM) and Periodic medical examination (PME) of employees and contract workers. 12.3 What are the Occupational Health Pl. give details of such programs taken by your mine/mine Amongst family members of employees
8.4 Does your Organization/Unit have a system of ‘Employee suggestion Scheme’ on safety issues? If so, please give details including provision of rewards, if any Whether any such scheme exists. If so at what level and what appreciation/reward system followed. May please elaborate 8.5 Does your organisation/unit have a comprehensive Disaster Management Plan including On-site & Off-site emergency plans? If so, please furnish salient features of the same If such plans exist, how clear and practical these plans are and whether any training and mock drills are carried out. 8.6 Describe safety emergency handling system in your Organization/Unit Whether the Organization/unit depends on external agencies for emergency handling or it has trained safety backed by a Safety and Occupational Health centre and an ambulance. Safety Awareness and Training 20 9.1 Does your Organization/Unit observe safety occasions? If so, give details of activities carried out Whether any specific programmes are organised. If so, how often and involving who all in the programme. Is it celebrated round the year with participation from all levels of employees including the top management, representatives from various functions, mock drills, programme for employee’s families and the community 9.2 Describe the type of Safety Signages used in your Organization/Unit Whether any safety signages exists. If so, Are these well exhibited and easily understandable by all? Are they available in English/ Local Vernacular/ Hindi Does it have extensive signage including figure/signs addressing employees and visitors, indicating safety zones (red, orange, green) if applicable, legible instructions at
Are findings of investigation (post-accident) recorded, responsibilities are fixed, actions taken are reviewed at unit head level including training, provision/ modification of facilities etc. The reports are reviewed at the joint safety committees and learning’s are shared amongst all sections of the unit. Are initiatives taken to provide budget & other resources for CAPA 8.4 Does the company/unit have a system of ‘Employee Suggestion Scheme’ on safety issues? If so, please give details including provision of rewards, if any. Whether any such scheme exists. If so at what level and what appreciation/ reward system followed. 8.5 What is the arrangement in the company/unit to handle accidents /emergency situation? Whether any laid down procedure exist. If so, Is it the responsibility of the shift in-charge to handle the emergencies or there is more elaborate arrangement in which back teams like security or other personnel in shifts are trained to handle emergency. Are mock drill or fire drills carried out with the involvement of Senior officers to assess the preparedness Safety Awareness and Training 20 Marks 9.1 Does your Company/Unit observe safety occasions? If so, please give details of activities carried out Is there any specific programme to celebrate ‘Safety Day’? What is the involvement level? Is Safety celebrated round the year with participation from all levels of employees including the top management, mock drills, programme for employee’s families and the Community around 9.2 Describe the type of Safety Signages used in your Company/Unit Whether any Safety Signages exists. If so, Are are well exhibited and easily understandable by all? Does it have extensive signages including in local language and in figure/signs addressing employees and visitors, indicating safety zones (red, orange, green) if applicable,
Periodic Medical Examination (PME) Year No. of employees eligible for PME (a) No. of employees completed PME (b) % b/a X 100 Year No. of new contract workers eligible for PME (c) No. of contract workers PME (d) % compliance d/c X 100 13.3 What are the Occupational Health Promotional activities in your organization/Mine? E.g workplace wellness program, canteen hygiene inspections, stress management program, hearing conservation program etc. Certified that the information has been verified & found correct: Worker’s Representative on the Safety Head of Safety in Mine/Organisation Committee Signature : …………………………… Signature : …………………………………… Name & : …………………………… Name & : …………………………………… Designation : …………………………… Designation : …………………………………… Seal of the Organization: .…………………………………..
12.4 Mention the details of Safety awards/ recognitions received by your Organization/Mine Whether any Safety Awards received from State/National Govt, Industry Association, International bodies. 13. Occupational Health Management System 10 Marks 13.1 Does your organization / mine have an Occupational Health (OH) Surveillance Program? If yes, what are the components of OH surveillance programs that are being carried out Whether the organization has any such programme. If so, how comprehensive is the same. Is it a well laid out structured OH surveillance program? Does it cover medical fitness, health surveillance, biological monitoring (if applicable) and Industrial hygiene survey? Are Action plans prepared and implemented? Is the OH survey limited to employees only Does it cover contractors’ workers, daily wage labor etc Does it nearby communities, who get effected by pollution load from the mine, unsafe practices 13.2 Give the percentage compliance of medical examination and periodic Medical examination of employees and contract workers for last 3 years in your organization/mine. Pre- employment Medical (PEM) Fitness Compliance Assessment is on the basis of coverage of Pre-employment medical (PEM) and Periodic medical examination (PME) of employees and contract workers. 13.3 What are the Occupational Health Promotional activities in your organization / mine? E.g. Workplace wellness program, canteen hygiene Pl. give details of such programs taken by your mine/mine Amongst family members of employees Amongst family members of contractors Amongst nearby villages, both in core (5km radius) and buffer zone ( 10 km radius)
POST APPLIED FOR: Assistant Cook NAME OF SCHOOL: Dene House Primary School 1. Personal details Title Name: Surname: Home address Street address: Town/city: County: Post code: Country of residence UK/EU Other If other please state Do you have the right to work in the UK? YES NO Do you require a work permit or VISA? YES NO If yes, please give details National Insurance Number If your mailing address is different to above please insert here Street address: Town/city: County: Post code: Telephone numbers (please only list numbers we should call to contact you) Work: E-mail address Home: Mobile: 2. Employment History (Please with most recent and explain any gaps) Job Title. Employer Name and Address Dates Reason for leaving
(Please refer to excel sheet ‘score sheet for assistant professors’ for filling the Score) (A) Published Papers in Journals S. No. Title with Page nos. Journal ISSN/ ISBN No. Impact factor Whether Peer reviewed. Impact factor, if any No. of Whether you are the first or corresponding author Score* S. No. of proof of enclosure *Please refer to excel sheet ‘score sheet for assistant professors’ for filling the Score (B) Articles/ Chapters published in Books S. No. Title with Page nos. Book Title, editor & publisher ISSN/ ISBN No. Whether Peer reviewed. No. of Whether you are the first or corresponding author Score* S. No. of proof of enclosure *Please refer to excel sheet ‘score sheet for assistant professors’ for filling the Score (C) Full papers in Conference Proceedings S. No. Title with Page nos. Details of Conference Publication ISSN/ ISBN No. No. of Whether you are the main author Score* S. No. of proof of enclosure *Please refer to excel sheet ‘score sheet for assistant professors’ for filling the Score (D) Books Published as author or as editor S. No. Title with Page nos. Type of Book & Authorship Publisher & ISSN/ ISBN No. Whether Peer reviewed. No. of Whether you are the main author S. No. of proof of enclosure *Please refer to excel sheet ‘score sheet for assistant professors’ for filling the Score (E) Ongoing Projects/ Consultancies S. No. Title Agency Period Grant/ Amount Mobilized (Rs lakh) S. No. of of enclosure *Please refer to excel sheet ‘score sheet for assistant professors’ for filling the Score (F) Projects Outcome/Outputs S. No. Title Agency Govt./Local Bodies) Period Grant/ Amount Mobilized (Rs lakh) Whether policy document/ patent as outcome Score* S. No. of proof of enclosure
Job application form East Sussex County Council is committed to the safeguarding and promotion of the welfare of all children, young people and vulnerable adults. Please complete all this form in type or black ink and use only the same size paper (A4) as continuation sheets. Guidance notes are included at the end of this form. Job details Job title Assistant Site Supervisor Location Causeway School Closing date for application Noon Friday 02 June 2017 Reference number Work arrangements (select as appropriate) Full time / part time / job If the post is full-time, would you be prepared to consider working on a job-share basis? (select as appropriate) Yes / No If job-share, please state preferred working arrangements: Personal details Surname First names Title (select as appropriate) Mr / Mrs / Miss / Ms / Mx / Other Maiden name or previous names Address Email address Correspondence Address (if different from Daytime telephone number Mobile Home Present employment Job title
Disability Guidance an applicant has a disability and they meet the essential criteria of the post they are automatically shortlisted for interview. This positive action helps ensure people with disabilities get their fair share of jobs. The Equality Act 2010 says that a person is disabled if they have a mental or physical impairment or long term health condition has a substantial adverse effect on their ability to carry out normal day-to-day activities. If you consider yourself to be disabled please let us know. We would appreciate advice on any assistance you may require or reasonable adjustments we might arrange to enable you to attend or participate in the interview, in compliance with the Equality Act 2010. Do you consider yourself to be disabled as set out in the Equality Act? (select as applicable) Yes / No If YES, please describe your disability. If you need any assistance to attend or participate in the interview, please give details. Religion Please identify your religion by putting an ‘x’ in ONE of the boxes below. Christian Buddhist Hindu Jewish Muslim Sikh Other religion No religion Prefer not to say Sexual Orientation Please identify your sexual orientation by putting an ‘x’ in ONE of the boxes below. Bisexual Gay man Gay woman / lesbian Heterosexual / straight Other Prefer not to say Gender Identity Is your gender identity the same as the gender you were assigned at birth? Yes No Prefer not to say Military Status Please identify your military status by putting an ‘x’ in the relevant box below, if required. Army Reserve Regular Reserve
(B) Publications other than Journal articles (books, chapters in books etc.) (i) Text/Reference, Books published by International Publishers, with ISBN/ISSN number S. No. Title with Page nos. Book Title, editor & publisher ISSN/ ISBN No. Whether Peer reviewed. No. of Whether you are the first or corresponding author API Score S. No. of proof of enclosure (B) (ii) Subject Books, published by National level publishers, with ISBN/ISSN number or State / Central Govt. Publications. S. No. Title with Page nos. Details of Conference Publication ISSN/ ISBN No. No. of Whether you are the main author API Score S. No. of proof of enclosure (B) (iii) Subject Books, published by other local publishers, with ISBN/ISSN number S. No. Title with Page nos. Type of Book & Authorship Publisher & ISSN/ ISBN No. Whether Peer reviewed. No. of Whether you are the main author API S. No. of proof of enclosure (B) (iv) Chapters in Books, published by National and International level publishers, with ISBN/ISSN number S. No. Title with Page nos. Type of Book & Authorship Publisher & ISSN/ ISBN No. Whether Peer reviewed. No. of Whether you are the main author API S. No. of proof of enclosure (C) Ongoing and Completed Research Projects and Consultancies (C) (i & ii) Ongoing Projects/Consultancies S. No. Title Agency Period Grant/ Amount Mobilized (Rs lakh) API Score S. No. of proof of enclosure (C) (iii) Project Outcome/Outputs S. No. Whether policy document/ patent/ technology transfer/ product/process Title Agency Whether International/ National/Central Government/ State Govt./Local bodies API Score S. No. of proof of enclosure
Full Chronological History Please provide a full history in date order with the most recent since leaving secondary education first, including periods of any post-secondary education/training, and part-time and voluntary work as well as full time employment. Please give start and end dates, explanations for periods not in employment or education/training, and reasons for leaving employment. Job or positon Name and address of school, other employer, or description of activity Number on roll and type of school, if applicable Full or (DD/MM/YYYY) Reason for leaving From To Please enclose a continuation sheet if necessary.
Sexual orientation Please tick Bi-sexual Gay Man Gay Woman Heterosexual Prefer not to say Gender Please tick Female Male Transgender Prefer not to say Personal relationship Please tick Single Living together Married Civil Partnership Prefer not to say Religion or belief Please tick No religion Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim Sikh Any other religion (Write in) Prefer not to say
e) Nationality f) Gender Male / Female g) Religion h) Community/Category GEN/SC/ST/OBC/Other Categories........................................... If other categories give details.................................................... i) Marital Status Married/Unmarried j) If physically disabled indicate the relevant particulars If applicability write “Yes” Percentage of Disability Sl. No. of Proof enclosed k) Permanent Address with Pin Code: Email: Mobile Landline( with STD code) l) Present Address with Pin Code for correspondence Email: Mobile: Landline with STD Code Educational Qualifications (attach additional pages if required) Attach one set of self attested photocopies of certificate(s) Exam Name of the Course Name of the Board/ university Month & year passed Division % of marks CGAP (if grading is application Subject studies S Sl.No. of proof enclosed 10th class/ Equivalent 12th Class/ equivalent Bachelor Degree Master’s Degree M. Phil /Equivalent Ph.D Indicate whether Ph. D degree has been awarded : Yes/No (only regular basis) If yes, please submit the followings Date of Registration Date of Submission Date of Notification Sl.No. of Proof enclosed NET UGC/CSIR/ASRB Fellowship, if any Subject Roll No. Year
APPLICATION FOR SEMESTER REGISTRATION Session Commencing on………………………. Semester..…………………… 1 Name of Student, Admn No and Date 2 Present Semester, Branch, Roll No 3 Class to which registration is sought 4 Year and Institution of 1st admission to course 5 Period of discontinuation and reason thereof 6 Percentage of attendance for the present semester 7 Details of condonation of shortage of attendance pertaining to any of the previous semesters 8 Address for communication (Email ID (in BLOCK) & Mobile Number) 9 Progress in previous semesters Class Session Attended University Reg. No. Month and Year of Exam Passed in full/Subjects/Remarks S1 S2 S3 S4 S5 S6 S7 10 Institutional and Departmental Dues 1 Fees 2 Library 3 Laboratory 1 4 Laboratory 2 5 Workshop 6 Hostel 7 Others
K CURRENT EMPLOYMENT (Please highlight all current employment) Dates Name and address of employer Position held and nature of duties From To Contract Current Salary: Period of Notice to be worked: L PREVIOUS EMPLOYMENT – Experience relevant for the post being applied for Dates Name and address of Employer Position held and nature of duties From To Reason for leaving
Description of the Class 7 dangerous goods Description of the packages UN number Isotope Physical condition Chemical condition Form Special form certificate^ Max. activity per package Package type Package approval certificate c Number of packages Solid Liquid Gas Special form Other form UN number Isotope Physical condition Chemical condition Form Special form certificate^ Max. activity per package Package type Package approval certificate c Number of packages Solid Liquid Gas Special form Other form UN number Isotope Physical condition Chemical condition Form Special form certificate^ Max. activity per package Package type Package approval certificate c Number of packages Solid Liquid Gas Special form Other form UN number Isotope Physical condition Chemical condition Form Special form certificate^ Max. activity per package Package type Package approval certificate c Number of packages Solid Liquid Gas Special form Other form UN number Isotope Physical condition Chemical condition Form Special form certificate^ Max. activity per package Package type Package approval certificate c Number of packages Liquid Gas Special form Other form
Description of the cargo Maximum activity per transport: Maximum transport index (TI) per transport: Maximum number of packages per shipment: Maximum number 20’ or 40’ containers per shipmentb: Fissile materialb Enrichment Uranium (%)b: Composition Plutoniumb: Massa fissile material per packageb: fissile material per packageb: Additional information Type of transport unit: Proposed or presumed transport DESCRIPTION OF THE DOCUMENTS Radiation protection programme The applicant states that the radiation protection programme added in the application for recognition as carrier of Class 7 dangerous goods also covers this application for authorisation or shipment approval. The applicant states to dispose upon a specific radiation protection programme for the Class 7 dangerous goods transport mentioned in this application for authorisation or shipment approval. A copy of the following document is added: Attachment 11: A copy of the radiation protection programme approved by the health physics organization Security The applicant states to fulfil the requirements of the security conditions regarding the Class 7 dangerous goods as indicated in chapter 1.10 of the ADR chapter 1.5.1 of the ICAO technical instructions and 1.6 of the IATA regulations chapter 1.4 of the IMDG code
APPLICATION FOR THE POST OF PERSONAL DETAILS – complete in block capitals Title by which you wish to be referred Mr Mrs Miss Surname First Name(s) Full Address Daytime Telephone Number Home Work Mobile Telephone Number Email Address National Insurance Number EDUCATION/TRAINING/QUALIFICATIONS From To Full/Part-Time/ Correspondence etc. Qualifications Grade Date RELEVANT NON QUALIFICATION COURSES ATTENDED Organising Body Course Details From To PRESENT EMPLOYER OR MOST RECENT EMPLOYER (if currently unemployed state “UNEMPLOYED”) Name and Address: Postcode:
Convictions Please give details of any convictions, cautions or any offence you have been found guilty of in any country including the date of the conviction or caution and the sentence imposed (a criminal record will not necessarily be a bar to obtaining a position). Road traffic offences should be included. (Depending on the role may be required to drive as part of the role.) Because of the nature of the work for which you are applying, this post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (exceptions) order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act other than those which are Protected. In the event of employment, any failure to disclose convictions or cautions or bind over orders which are not Protected could result in dismissal or disciplinary action by the academy. N.B. However please note that you do not have to disclose Protected Cautions or Protected Convictions to us. Protected Convictions and Protected Cautions are defined as follows: Protected convictions A conviction is a "protected conviction" if: It does not relate to a "listed offence", such as violent and sexual offences. () No custodial sentence was imposed. You have no other convictions. (I.e. if you have more than one conviction you will need to disclose all convictions) It was received by you whilst aged under the age of 18 at the time of the conviction and five and a half years or more have elapsed. It was received by you whilst aged 18 or over at the time of the conviction and 11 years or more have elapsed. Protected Caution A caution is a "protected caution" if: It does not relate to a listed offence. () It was given to you whilst aged under the age of 18 at the time of the caution and two years or more have elapsed.
Rehabilitation of offenders act 1974 (Exemptions Order 1975) The nature of the work you are applying for could involve direct contact with vulnerable people and we are obliged to ask you, in connection with this application, to disclose any convictions you may have. Under the conditions of the above Order you are not entitled to withhold information about convictions which might otherwise be regarded as “spent”. In the event of employment, failure to disclose such convictions could result in dismissal or disciplinary action. Would you be willing to undertake a Disclosure and Barring Service check? Yes No Equality and Diversity Monitoring Healthwatch Dudley is committed to a policy of ensuring equality of opportunity in employment for all. The information below will be used for monitoring purposes and will be treated confidentially. All unsuccessful application forms are destroyed after six months. 1. Which of the following options best describes how you think of yourself? Male Female 4. Do you have any form of disability? Yes No If yes, please give details ____________________________________________________________________________________ 3. Which of the following options best describes how you think of yourself? Please tick the appropriate box 1 White UK 6 Bangladeshi 2 White Irish 7 Chinese 3 Other (please specify) 8 Indian 9 Pakistani 4 Black African 10 Other (please specify) 5 Black Caribbean did you see the position advertised? Newspaper Which one? Website Which one? E-bulletin Which one? Twitter Which one? Other Please give details: If completing this form online please print off and sign this sheet and send to us by post (we must receive your emailed application before the deadline, but the printed sheet can arrive after) I declare that the information in this form is true and complete – I understand that any wilful misstatement or omission renders me liable to disciplinary action if appointed. Signature: Name in capital letters: Date:
and Black Caribbean White and Black African White and Asian Any other mixed background* Chinese or Chinese British/ Other Ethnic Group Chinese Other Ethnic Group* *Please specify GENDER: Male: Female: AGE: 16-24 25-35 36-45 46-55 Over 55 Do you consider yourself to have a disability: Yes / No If yes, what is your disability: A disability may be defined as “A physical or mental impairment which has a substantial and long-term effect on the person’s ability to carry out normal day-to-day activities” Thank you for your assistance. Please return this questionnaire with your application form. FOR OFFICE USE ONLY Candidate No. Closing Date: 18 June 2018 Corporate functions X Strategy & Performance Support to Community & Business Support to Land Managers Access & Recreation Field Services Support to NP Users Support to NP Pinkery Support to NP Users - NPC Is the position: Full Time x Part Time (Less than 30 A-B C-D E-F X G-H I+ Shortlisted: Yes / No Appointed: Yes / No
Fundamental information Name of the city & Country Structure & size City Metropolitan area Population: What kind of visit do you want to attend? Work placement Study visit Are you member of the CIVITAS Community? CIVITAS demonstration city CIVITAS Forum network city CIVINET member city IA or RIA project partner city None Has your city been awarded an award for its work on sustainable mobility? If yes, which one? CIVITAS award EUROPEANMOBILITYWEEK award SUMPs award Other (please specify) My city has applied or has been short listed but not selected None Do you have recent experience of exchange? If yes please specify Yes (Please specify below) No Preparing the visit What are the main reason(s) why you want to take part to a CIVITAS peer-to-peer Which theme(s) do you want to learn about during your visit? Clean fuels and vehicles Collective passenger transport Car-independent lifestyles Demand management strategies Integrated planning Mobility Management Public involvement Safety and security Transport Telematics Urban freight logistics Other: (please specify)
MINNESOTA STATE SERVICES FOR THE BLIND COMMUNICATION CENTER SUPPLEMENT An approved application for free library service entitles you to use all services available from State Services for the Blind's Communication Center in St. Paul. Check the services that you want: Radio Talking Book. Daily newspapers, current magazines, and the latest best sellers are read over a closed circuit radio reading system called the Minnesota Radio Talking Book Network. If you check this item, a special radio will be sent directly to you. Transcription Services. Textbooks, reference books, manuals and other printed documents needed for work, school or leisure may be requested. If not available from the Minnesota Braille and Talking Book Library in Faribault, or other national sources, books are transcribed into digital audio, cassette tape or braille format by Communication Center volunteers. If you check this item, an informational packet will be mailed to you explaining the procedures for transcribing. Telephone-based news services. Two telephone-based news services supported in part by funds from the Minnesota Department of Commerce’s Telecommunication Access Minnesota (TAM) fund, are available 24 hours per day. If you pick one or both services, a staff number will call to set it up. Dial-in News. A free service providing daily and weekly Twin Cities newspapers. Using a touch-tone telephone anywhere within the Metro dialing area, you may access the Star Tribune, the St. Paul Pioneer Press and City Pages at your convenience. NFB-NEWSLINE® for the Blind. A free service providing local and national newspapers. Using a touch-tone phone, you may access the Star Tribune, St. Paul Pioneer Press, the Duluth News Tribune, and over 300 other out-of-state and national newspapers and magazines including the Grand Forks Herald, USA Today, Wall Street Journal, and the New York Times. For correspondence via e-mail, provide your address: E-mail address:
Sexual orientation Please tick Bi-sexual Gay Man Gay Woman Heterosexual Other Prefer not to say Gender Please tick Female Male Transgender Prefer not to say Personal relationship Please tick Single Living together Married Civil Partnership Prefer not to say Religion or belief Please tick No religion Christian (including Church of England, Catholic, Protestant and all Christian denominations) Buddhist Hindu Jewish Muslim Sikh Any religion (Write in) Prefer not to say
Secondary Education and Qualifications (e.g. GSCE) Name of school/college From To Qualifications gained Further or Higher Education Please provide details of any recognised qualifications or courses attended which are relevant to the job application. Name of FE college, university or awarding body Full or part-time Qualifications obtained From To
Name Address Applicants Name(s) Property applied for Scheme Share to be purchased ______ % Amount of mortgage to be raised £ _______________ Amount of deposit £ _______________ YOUR EXISTING ACCOMMODATION (please complete all sections that apply) APPLICANT 1 APPLICANT 2 Council tenant Housing Association tenant Private tenant with family Share with friends Homeowner Other (please state) YOUR EXISTING ACCOMMODATION CONTINUED APPLICANT 1 APPLICANT 2
Type of debt Company Amount owed Monthly payment Type of debt Company Amount owed Monthly payment £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ £_______ COUNTY COURT JUDGEMENTS APPLICANT 1 Company Amount owed Monthly payment Is it active? If not active, when was it settled? Do you have a notice of satisfaction? £_________ £__________ £_________ £__________ APPLICANT 2 Company Amount Owed Monthly Payment Is it active? If not active, when was it settled? Do you have a notice of satisfaction? £_________ £__________ £_________ £__________ HAVE YOU PREVIOUSLY APPLIED FOR OR HAD A PROPERTY WITH ALLIANCE HOMES? APPLICANT 1 APPLICANT 2 Yes No Yes No ARE YOU AN ALLIANCE HOMES MEMBER OF STAFF? APPLICANT 1 APPLICANT 2 Yes No Yes No
Top ten debtors on who you would like us to indicate availability of cover: Terms of payment Amount currently outstanding R R R R R R R R R R Credit limit required R R R R R R R R R R Banking details Registration number Full physical address Registered name of debtor & trade style
TRAINING MEMBERSHIP OF PROFESSIONAL BODY NAME OF PROFESSIONAL BODY LEVEL OF MEMBERSHIP DATE ACHIEVED MM/YY WORK HISTORY PRESENT EMPLOYER: NAME & ADDRESS OF EMPLOYER POSITION HELD & BRIEF OUTLINE OF DUTIES PRESENT SALARY, SCALE/GRADE & REASON FOR LEAVING PREVIOUS EMPLOYERS – Most recent first. Show any gaps in employment and indicate what you were doing in that time, including voluntary work if you wish.
CONFIDENTIAL APPLICATION FORM Please note that this is the standard Church of England form with an amended heading, an additional section numbered six and subsequent sections re-numbered. Application for the office of Vicar of Christ Church, Paignton & St Paul, Preston SECTION 1 Surname Christian names Address Home telephone number Mobile number E-mail Ordained deacon in the Diocese of In (year) Ordained priest in the Diocese of In (year) Lay ministers licensed/commissioned in the Diocese of In (year)
SECTION 8– CONFIDENTIAL This section will be removed by the person administering the application process and will only be made available to the chair of the interview panel and the bishop. If you are appointed to the office you will be invited to provide information about you and your family so you can receive appropriate pastoral care. References: Please give names, occupations and addresses (including e-mail if possible) of three persons to whom reference can be made and the capacity in which they have known you. At least one should be clerical (not the bishop as his reference is sought as a matter of course) and one from a senior lay person – for example a current churchwarden or head teacher of the local school. Referees should have a detailed up-to-date knowledge of your work. Please obtain their permission. If you are a team vicar, priest-in-charge of a daughter church or assistant curate, you should give your team rector’s or incumbent’s name as a reference.
This person can be approached prior to interview Yes No (Please tick as appropriate) Type of Reference (please indicate) Employer Academic Referee 2 Name (including title) Job title or status Capacity in you know this person Organisation Postal address Postcode Telephone number E-mail address This person can be approached prior to interview Yes No (Please tick as appropriate) Type of reference (please indicate) Employer Personal Academic 6. DISCIPLINARY ACTION If you are currently employed, do you have a current disciplinary sanction(s) against you? Yes No If yes, please give brief details: If you are currently unemployed, did you have any disciplinary sanction(s) against you on the date that you left your employment? Yes No If yes, please give brief details: 7. ELIGIBILITY TO WORK IN THE Nationality Do you have the right, under immigration rules, to live and work in the ? Yes No Unsure
– White and Black African Other Black Background ________________ Mixed – White and Asian Chinese Other – Mixed Background _______________ Other Ethnic Background ________________ Asian or Asian British – Indian Not Asian or Asian British - Pakistani I prefer not to say 10. Are you related to an employee(s) or trustee(s) of Crossfields Institute? Yes No If yes, please give details: Name__________________________ Position __________________________________ Relationship to you ______________________ I confirm that the information is correct to the best of my knowledge. I consent to Crossfields Institute processing, by means of a computer database or otherwise, any information I provide for the purpose of employment by Crossfields Institute, in accordance with the Data Protection Act 2018. Signature ______________________ Date _____________ you for completing this Diversity and Equal Opportunities Form. Please ensure that you return it with your fully completed application form. Crossfields Institute – Human Resources
Secondary Education and Qualifications Name of school/college From To Qualifications gained with date Higher Education Name and address of university, college and/or university education department Dates Full or part-time Courses/subjects taken and passed Date of examination and qualifications obtained Age groups for which trained From To
Part 3: Equality and Diversity Monitoring This section will be separated from part 1 and part 2. Collection of equality information is solely for monitoring purposes to ensure that our policies and procedures are effective. We also collect this data in accordance with the general and specific public sector equality duties under the Equality Act 2010. Any data you enter onto this monitoring form will only be used for monitoring purposes and will not be used in assessing and or scoring your application or during the interview process. This information is kept fully confidential and access is strictly limited in accordance with the Data Protection Act. Ethnicity Workforce census code Please tick White WBRI British English Welsh Northern Irish Scottish WIRI Irish WIRT Traveller of Irish Heritage WROM Gypsy / Roma WOTH Any other White background Mixed MWBC White and Black Caribbean MWBA White and Black African MWAS White and Asian MOTH Any other Mixed background Asian or Asian British AIND Indian APKN Pakistani ABAN Bangladeshi CHNE Chinese AOTH Any other Asian background Black or Black British BCRB Black – Caribbean BAFR Black – African BOTH Any other Black background Other ethnic group ARAB Arab CHNE Chinese REFU Refused/Prefer Not to Say OOTH Any other ethnic group
2. EDUCATION School / College (including addresses) Dates (From / To) Qualifications* Grade/Level Awarding Body Date of Further / Higher Education Dates (From / To) Qualifications* Grade/Level Awarding Body Date of Award Other Training Dates (From / To) Relevant Certification / Qualifications* Grade/Level Awarding Body Date of Award Please continue on a separate sheet if required * Proof of qualifications may be required at interview.
Section 5: References Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are. (NB. References will only be taken with your permission and if we wish to offer you a job). Reference 1 Reference 2 Name: Name: Their position / job title: Their position / job title: Work relationship with you: Work relationship with you: Organisation: Organisation: Dates employed: Dates employed: Address (including post code): Address (including post code): Telephone number: Telephone number: e-mail address: e-mail address: Section 6: Declaration I confirm that the information provided in this application is both truthful and accurate and that I have omitted no facts that could affect my employment. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. Signed: Date: Please send your completed form by 12 noon on Monday 3 December 2018 to: , with “Communications manager post” as the subject title. The monitoring form should be sent to the same address.
costs, material/ equipment, administration, venue hire, marketing, insurance Your contribution (Cash) $ $ $ $ $ $ $ $ $ $ $ $ $ $ Your contribution (In-Kind) ( ____Hours x $____ rate). Provide detail of tasks: $ In-kind labour ( ____Hours x $____ rate). Provide detail of tasks: $ In-Kind goods or services Please provide description of what is being provided: $ In-kind or services Please provide description of what is provided: $ Total income $ Total expenditure $ Please note: Total INCOME including In-Kind (if applicable) MUST EQUAL Total EXPENDITURE Attach additional pages/documents in support of your application if necessary. All applications must provide a quote prepared within the past three (3) months to verify the costs associated with the project or event. Please provide evidence of your contribution and attach with your application (eg: detailed financial statement or Treasurer’s report for the past 2 years). Refer to Page 8 of Guidelines under ‘Cash contribution’. Category 2 applicants only – Community Events and Support Provide details of the component to be funded by Council. Please itemise the specific component(s) that Council funding will be expended upon (eg: hire of stage, hire of performers, marketing, COPACC hire assistance etc)
EQUAL OPPORTUNITIES MONITORING We are an equal opportunities employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of age, race, ethnic or national origin, disability, gender, religion, beliefs, sexual orientation, domestic circumstances, social and employment status, HIV status, gender reassignment, or political affiliation. Our selection criteria and procedures are frequently reviewed to ensure that all individuals are selected, promoted and treated on the basis of their relative merits and abilities. All employees are given equal opportunity and are encouraged to progress within the organisation. The information on this form will be treated in confidence and will not be used as part of the selection process. This monitoring form will be separated from your application form on receipt and will not be seen by the recruitment manager. We are committed to an ongoing programme of action to make this policy fully effective. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:- Post applied for: Where did you see this post advertised? Newspaper and Date Job Centre Website www. Word of Mouth Referred by a friend (please name the individual) Other (please specify) GENDER Male Female ETHNIC ORIGIN I would describe my ethnic origin and/or nationality as:-
Basic info Company / Name Address Email Contact person Website Climate-KIC affiliation I work at a partner university I work at a partner company Accelerator Stage 1 Stage 2 Stage 3 Alumni Pathfinder Active pathfinder Alumni Other - please specify: CLC/RIC/RIS affiliation: If company Year of incorporation Turnover Number of employees If researcher University Field of expertise Challenge Buildings Flooding – solution for the city Flooding – solution for the citizens Urban Heat Islands Smart City Maturity of solution Proven & implemented in other places Proven, but not implemented Not proven yet – co-development and tests still needed
Date Name & address of employer Job title & duties Salary on leaving Reason for leaving Leisure Please note here your leisure interests, sports and hobbies, or pastimes, etc. Employment History (Please commence with most recent employer and provide a 10 YEAR employment history, or your entire Employment history if less than 10 years) 2 Please provide details of three referees who can provide information relating to your competency in a caring role, one of whom must be your present or most recent employer (referees for qualified Nurses must be professionals). If you are a student, please give an academic referee. If you are applying for a post requires unsupervised access to children/vulnerable adults, we reserve the right to approach any past employer for a reference. Name: Name: Name: Position: Position: Position: Organisation: Organisation: Organisation: Address: Postcode: Address: Postcode: Address: Postcode: Tel No. Tel No. Tel No. May we approach the above prior to interview? Yes/No May we approach the above prior to interview? Yes/No May we approach the prior to interview? Yes/No General Comments You may wish to set out below the principal reason for your application and highlight main achievements to date and the strengths you bring to this post. Continue on a separate sheet if necessary.