zilongwang/ReadingBank huggingface dataset:
B.1 CURRENT EMPLOYMENT STATUS Please tick the correct status of employment Permanently Employed Not Permanently Employed Self Employed Other, Please specify: Current/Most Resent Employer Name Position/Job Title In The Organization Period Of Service (attach certified copy of service letter) From: Till: Employer Physical Address Street City/Town Postal Code Municipality Postal Address PO Box City/Town Postal Code Province E Cape N Cape W Cape FS KZN Mpumalanga Limpopo Gauteng N West Contact Details (Reference) Contact Person Position Phone No. Cell No. E-mail Fax No B.2 Previous Employer Name Position/Job Title In The Organization Period Of Service (attach certified copy of service letter) From: Till: Contact Details of manager or supervisor Contact Person Position Phone No. Cell No. E-mail Fax No B.3 Previous Employer Name
Sources of Income for Children Type of Income Examples Earnings from work A child has a job where they earn a salary or wages. Social Security -Disability payments -Survivor Benefits A child is blind or disabled and receives Social Security benefits. A parent is disabled, retired, or deceased and their child receives social security benefits. Income from persons outside the household A friend or extended family member regularly gives a child spending money. Income from any other source A child receives income from a private pension fund, annuity or trust. Earnings from Work Public Assistance/ Alimony/Child - Salary, cash bonuses - Net income from (farm or business) If you are in the U.S. Military: - Basic pay and cash bonuses (do not include combat pay, FSSA, or privatized housing allowances) -Allowances for off-base housing, food and clothing - Unemployment benefits - Workers Compensation - Supplemental Security Income (SSI) - Cash Assistance from State or local government - Alimony payments - Child support payments - Veteran’s benefits - Strike benefits
2: The organisation is legally constituted and not for profit. Evidence: e.g. membership eligibility policies and procedures 3: The organisation has been operational for a minimum of years and is financially solvent. Evidence: e.g. associations incorporation number, ABN 4: Is itself, or is a member of, either or ; or can otherwise demonstrate how the organisation delivers a significant benefit to the Victoria sport and recreation sector. Evidence: e.g. annual reports and audited financial statements for previous 3 years 5: The organisation is not a sporting club, league or similar grouping; and has either a wide, broad population or multi regional focus. Evidence: e.g. letter of affiliation with national sporting organisation
Individual Application for State In-Service Training Program A note to Training Approval Officers: This application is provided for your agency’s internal use only. Important notes to Applicants: Direct all questions regarding timelines and procedures to your agency Training Approval Officer. Each agency has unique policies concerning deadlines, eligibility, and the registration process. Be sure to carefully check the dates and times of the courses for which you are applying, for any potential conflicts. No seat changes or withdrawals are allowed once seats have been assigned. Certificates will be issued at the end of each course. Employees who leave at any point before the instructor ends the class will not be given a certificate. Maps and driving directions are available online: http://bor.ct.edu/inservice/docs/Maps and Directions.docx Information about the Applicant: Name: Title: Phone: Department: Address: Course Information - One Course Per Page: Course Title: Course Number: Date(s): Fee: I meet the prerequisites listed in the course description: ____Yes ____No ____None Listed Supervisor’s Approval Name: Title: Signature: Date:
SCRUTINY REPORT OF M/s. ____________________________ BY AEO TEAM, WRU, MUMBAI. Applicant : M/s. Head Office : Registered Office & Factory 1 Address : Factory 2 Address : Factory 3 Address : Contact Person : Type of Category : Application for : AEO – T1 Status M/s. ________________________________________ filed application on ____________ in prescribed format as per CBEC Circular No.33/2016-Customs dated 22.07.2016, seeking AEO-T1 Accreditation. On the basis of the documents submitted the said application is scrutinized as below: Sr. No. Eligibility Criteria to meet the objective Remarks Eligibility Conditions and Criteria for granting the AEO Certificate 1 Whether company has a certificate of registration issued by the Registrar of Companies 2 Whether details of places/ locations where goods are being handled, e.g. loading, unloading, storage etc., in the course of supply to/from international supply chain are provided by the company 3 Whether company has provided any Proof about the business of its own accounts 4 Whether applicant had business activities for at least three financial years preceding the date of application 5 Whether applicant has minimum 25 transactions either of Import or Export transactions Legal Compliance 6 Whether any show notice issued to them during last three financial years involving fraud, forgery, outright smuggling, clandestine removal of excisable goods or cases where Service Tax has been collected from customers but not deposited to the Government.
Please note that only institutions that are approved by the Commission to award baccalaureate degrees and that have received approval from applicable oversight agencies may apply for master’s degree approval (Section II (C)(4)(a)(ii), Substantive Standards, Standards of Accreditation). School # School Name Type City State Degree Granting Main: Yes: Branch: No: Contact Person Phone Email Program Title (e.g. Business Administration) Length of Program (in Months) Full Credential & Abbreviation (e.g. Master of Science – MS) Proposed Start Date Course Distribution (Must the Outline of a Degree Program form) Standards Semester/ Quarter Credit Hour Requirements School Externship Information (Externship as listed on the Outline of a Degree Program; may include multiple courses) Semester Credit Quarter Credit Hours Technical 24/36 Total Externship Clock Hours: Electives / Non-Technical* 6/9 Total Externship Credit Hours: Total 30/45 *The school is not required to have Electives / Non-Technical courses, however if the degree requires only technical courses, the degree must have at a minimum 30 semester / 45 quarter credit hours of technical courses. ELIGIBILITY CRITERIA (Select One): YES NO The school is currently approved to an ACCSC-approved baccalaureate degree program. The school is currently approved to offer an ACCSC-approved Master’s degree program. The proposed degree program is approved to be offered at an affiliated school. If YES: please submit the copy of the approval letter and Outline of Degree Program. I certify that the information herein and attached hereto is correct and that this degree program has not been described in the catalog, advertised or offered to students. Name Signature Title Date
Application for the GU President Scholarship Office of International Affairs, Gachon University 1342 Seongnam-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do 461-701 Korea TEL : +82-31-750-5823 / FAX : +82-31-750-5674 E-mail : Website : http://oia.gachon.ac.kr Photo 4×5 cm 1. Personal Information Name Korean English Nationality Birthplace Date of Birth Gender □ Male □ Female Marital Status □ Single □ Married Religion Hobby Physical Condition Contact Information (Home) Address ( ) Phone Number Fax E-mail Contact Information (Work) Address ( ) Phone Number Fax E-mail
I to provide my personal information for the needs of GU President Scholarship application procedure under Article 15 ~ 22 in the Personal Information Protection Law. Consent Details Collected Information Purpose of Collecting Period of Utilization and Possession Photo, name, date of birth, address, academic background & qualifications(Institutions attended, major, graduation date, working experience & qualifications, etc.) Identification & references for selection of scholarship recipients / To support and supervise the scholarship recipients in Korea. · Selected Students : Permanent E-mail address, Phone number To make Announcements and provide information, etc. Condition after graduation (Address, job information, etc.) Post scholarship management, etc. Permanent 2014. MM. DD Name :(Signature) To President of Gachon University
Telephone Number………………………………….. Mobile Number………………………. E – Mail………………………………………………………………………………………… Date of Advertisement:………………………Newspaper………………………………….. 6. Date of Birth:………………………Place of Birth…………………………Age………..…….. 7. Are you a Citizen of India: Yes/ No, If Yes by Birth / by Domicile…………………………… 8. What Languages (including Indian) can you read, write and speak. Name of Language Read, Write and Speak Examination passed, if any 9. If appointed, what notice would you require before joining the post:…………………………. 10. Educational Qualification: Fill up the details in Table – I attached. 11. Working Experience: Fill up the details inTable – II attached. 12. Have you done any research work, or published papers. If yes, give the details. (Attach separate sheet showing list of publication, if required). Publications International Journal National Journal International Conference National Conference Numbers 13. Are you approved teacher by any of the University for M. E. and Ph. D? If yes, Name of the University Date of Approval Number of StudentsGuided M.E.
Table - I 10. Give the details of all examinations passed commencing from matriculation or its equivalent examination. Attach true copy of all certificates. Sr. No College/ Institute University/ Board Date of Joining Date of Leaving Year and Month of Passing Exam Passed Field of Specialization Class Obtain of Marks 1 2 3 4 5 6 Table - II 11. Give details of Experience if any, attach true copy of experience certificates. Sr. No. Name of Employer Post Held Nature of Duties Date of Joining Date of Leaving Last Salary Drawn Reason of Leaving Remark*
vi vii viii 9 Name and contact no of individual(s) engaged with professionally in the past and can stand referee to vouch for the credentials listed out in this application. 10 Educational Qualifications Name of the Degree/Diploma etc/Full –Time/Part Time Name of the Year of passing Class/Grade received i ii iii
APPLICATION FOR VIREMENT (COPIES TO BE SUBMITTED TO THE SECTION DIRECTORS, DISTRICT OFFICE & DIRECTOR OF FINANCE) MINISTRY SERIAL: VIREMENT REQUEST NO.: DATE: Application is made for virement of funds to: Allocation: Name: State Allocation[ $] Title: VARIOUS Revised budget YTD : [$] Less Total Expenditure(YTD): [$] Total Available Balance : [$] Amount of Savings to be Applied: Which allocation: [$] State the Purpose; NOTE: [VIREMENT of FUNDS is made from secondary and primary allocation to new centralized secondary and primary allocation expenses.] …………………………………… School head/Manager Recommendation For Approval; Virement Approved/Not Approved …………………………………. ……………………. PERMANENT SECRETARY Date Ministry of Education, Heritage & Arts For FEMIS Updating: MOEHA/IT Date Received: ………………………… Date entered into system: ……………………………… IT Officer: ……………………………
Senior Citizens’ Centre Student Service Centre Youth Centre Eldercare Centres Active Ageing Hub Senior Care Centre Day Rehabilitation Centre Senior Activity Centre Purpose for Proposed Facility Please provide reasons for setting up the facility Description of Services/ Programmes of Proposed Facility Please provide the following information on the services/programmes to be operated in the facility: Name of programme Description Target Clientele and needs Age No. of clients served per year Regularity Desired outcomes E.g. Befriending, counselling Programme to engage youths and to be a friend by lending a listening ear. Youths who are exhibiting signs of being at-risk, seniors, people with special needs 14 to 80 yr old 50 Daily, Weekly, Monthly with special have improved relationship with others. Please indicate the areas that the programmes will serve. E.g. Bishan, Ang Mo Kio Constituency, whole of Singapore etc. How will the programmes meet service and address service gaps in the community?
DRIVER'S EMPLOYMENT BACKGROUND NAME: LAST, FIRST MI SSN: DATE OF BIRTH: PRESENT ADDRESS: PREVIOUS ADDRESSES FOR THE LAST THREE (3) YEARS: CURRENT DRIVER'S LICENSES STATE LICENSE NO. TYPE EXPIRATION DRIVING EXPERIENCE CLASS OF EQUIPMENT TYPE OF EQUIPMENT (VAN, TANK, FLATBED, ETC.) DATES OF OPERATION TOTAL MILES OF OPERATION FROM TO ACCIDENT RECORD FOR PAST FIVE(5) YEARS (ATTACH AN ADDITIONAL SHEET IF NEEDED) DATE NATURE (HEAD ON, ETC.) NO. OF FATALITIES NO. OF INJURIES LAST ACCIDENT NEXT PREVIOUS NEXT PREVIOUS TRAFFIC CONVICTIONS FOR THE PAST FIVE (5) YEARS (OTHER THAN PARKING VIOLATIONS) LOCATION (CITY & STATE) DATE CHARGE PENALTY YES NO A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? ❑ ❑
Application Form Dr. /Mr./ Ms. Contact Address Email Phone/Mobile Date of Birth (DD/MM/YYYY) Gender (M/F) Nationality Caste (Please enclose Caste Certificate) Name & Address of the Institution/University Department/School Year of Joining Supervisor’s Name Research Interests Total No. of Publications Details of Publications if any (attach a separate sheet if needed
REFERENCES Please give the names, addresses and occupations of two referees, one of whom should be your current or most recent employer (preferably the Head). Where you are not currently working with children but have done so in the past one referee must be from the employer by whom you were most recently employed in work with children. Please note references will not be accepted from relatives or from referees writing solely in the capacity of friends. Please state how the referee knows you. The School reserves the right to take up references from any previous employer. Referee 1 Name: Address: Town: County: Post Code: Telephone No: Email Address: How does this referee know you? Do you object to referee being contacted before interviews Yes /No Referee 2 Name: Address: Town: County: Post Code: Telephone No: Email Address: How does this referee know you? Do you object to referee being contacted before interviews Yes /No CRIMINAL RECORD
Address History for you for the last 5 years Address Did you rent, own or stay with someone at this address Reason for leaving Contact details for the owner of the property Address History for your partner if different from for the last 5 years (if not relevant go to question 4) Dates Address Did they rent, own or stay with someone at this address Reason for leaving Contact details for the owner of the property 4. Children who do not live with both parents (If not relevant go to question 5) Child’s name Other parent’s name Their contact number Their address Do you have contact with them Does your child have contact with them How often is this contact How long has this arrangement been in place Can your child live with their other parent Any other relevant information
Household Support Network (if not relevant please go to question 7) Professional Household member Name of professional Address and Contact Number Type of support received Social Worker Probation Officer Community Psychiatric Nurse Carer(s) Any unregistered childcare support e.g. family or friends Other please specify Disabilities and long term medical conditions (if not relevant go to question 8) Household member Name of diagnosed illness or disability and how it impacts your day to day life Medication taken, including dosage, how often you take the medication and date medication started Any special requirements relating to the type of accommodation or location you can live in e.g. if you need adaptations in your home or need to be close to a specialist treatment centre
Rs. Rs. Lowest Highest Name under which employed Your job title Your job duties (be specific): Reason for leaving : Better opportunity. 3. Current or most recent employer: Employment dates: From Year To _ Month Year Average hours worked per week Salary: (per month) Rs. Lowest Highest Business phone number : Complete mailing address City District Zone Supervisor’s Name : Name under which employed : Your job title Your job duties (be specific): Reason for leaving: 4. Current or most recent employer: Employment From Month Year To Month Year Average hours worked per week Salary: (per month) Rs. Lowest Highest Business phone number Complete mailing address City District Zone Supervisor’s Name: Name under which employed: Your job title: Your job duties (be specific): Reason for leaving: References Please list three (3) persons not related to you, who have knowledge of your work qualifications and can serve as a reference for you. Name Address Telephone 1. 2. 3. Special Skills
E-mail: E-mail: Additional Information To the best of your knowledge, are you related to any Councillor of the Oadby and Wigston Borough Council and/or to any of its employees? If yes, please state their name(s): did you see the advertisement for this post? Declarations IMPORTANT: This Authority is an Equal Opportunities Employer. You are asked to complete the Monitoring of Employment Practices form. Applications are welcome from disabled persons who feel they are capable of undertaking the duties associated with the post. CRIMINAL CONVICTIONS I understand that some posts (including those of Solicitor, Chartered or Certified Accountant) and those which involve working with vulnerable individuals (including children, the elderly, sick or disabled) will require me to give details of any criminal convictions. I confirm that I shall provide the information required on a questionnaire when requested and agree it may be checked against police records. DECLARATION I declare that the information given in this application is true. I shall not approach any Councillors and/or employees of the Oadby and Wigston Borough Council in order to advance my application, as I understand this shall disqualify me from further consideration. Furthermore, I understand that the provision of false information shall result in the termination of any contract entered into. Print Name: Date: Signed: This application from should be returned by either e-mail or post to: Resources, Oadby and Wigston Borough Council, Bushloe Station Road, Wigston, Leicestershire, LE18 2DR HR@oadby-wigston.gov.uk
REFEREES for …………………………………………… (Name) Applicant PLEASE PROVIDE NAME, ADDRESS AND TELEPHONE NUMBERS OF REFEREES, ONE OF WHOM SHOULD BE YOUR PRESENT EMPLOYER. Name: Name: Name: Position: Position: Position: Address: Address: Address: Telephone Number – Work: Email: Telephone Number - Work: Email: Telephone Number - Work: May we contact this referee before interview? YES / NO May we contact this referee before interview? YES / NO May we contact this referee before interview? YES / NO Capacity in which you are known to Referee, eg Employer Capacity in you are known to Referee, eg Employer Capacity in which you are known to Referee, eg Employer DECLARATION I am applying for the post of …………………………………………… at Belmont Grosvenor School. I confirm that the information supplied is complete and correct. I understand and agree that any untrue or misleading information will give Trust the right to terminate any employment contract offered and to make possible referral to the police. By sending this application form electronically I confirm that the information enclosed is accurate and truthful. Signed: ……………………………………………………………………………. Date:
Please refer to the Council’s Street Naming and Numbering Policy on our web site before suggesting street or house names. Please note that we will check for similar names in the locality and consult with Royal Mail for their views to ensure that the proposal does not create difficulties for postal or emergency services. If the development involves the creation of one or more new streets, the developer can suggest names for consideration. Please provide suggestions below together with the reason for the suggestion. Suggested Name Reason 6. House Names Please list, in order of preference, suggested house names below. Suggested 1 2 3 7. Fees (including VAT) New Developments Inc VAT 1 plot £120 2-5 £240 6-10 plots £360 11-20 plots £600 21-50 plots £1200 51 + plots £1800 Naming New Street No charge Property Name change / add alias £60 Changes to Layouts after SNN process completed No charge Confirmation of Address No charge Renaming Street No charge For card payments please contact us on 01508 533811 or send a cheque payable to South Norfolk Council These charges include liaising with Royal Mail and other organisations, together with the subsequent notification of address changes to emergency
34 St Michael’s Park Bristol BS2 8BW (rear of the University Social Sciences Library) Tel: 0117 927 6077 Email: Registered with Ofsted APPLICATION FOR A NURSERY PLACE 1. Child’s Forename(s): Child’s Surname: Name child goes by: 2. Date of Birth OR Due Date (dd/mm/yyyy): 3. Gender (please circle): M F 4. Child’s main Home Address (including postcode): 5. Family email address(es): 1. 2. Details of child’s carer 1: 6. Name of carer 1: 7. Telephone: (home) (work) (mobile) 8. Are you (Carer 1) a current University of Bristol student Y N If Y, name of course and student number? 9. Are you a current member of staff, please provide payroll number ( ) and name of Faculty _____________________ Y N (If carer 1 is UoB staff) Will you be eligible to join the nursery salary sacrifice scheme for payment of nursery fees? Y N N/A 10. Expected course completion date or end of contract (if fixed term staff) dd/mm/yyyy If you are a student, (please circle): Undergraduate Postgraduate 11. Will you be a UoB staff member or student when your child will start at the nursery? Student Y N Staff Y N Further information (e.g. your start date): Details of child’s carer 2:
12. Name of carer 2: 13. Telephone: (home) (work) (mobile) 14. Are you 2) a current University of Bristol student Y N If Y, name of course and student number? 15. Are you a current member of staff, please provide payroll number ( ) and name of faculty ____________________ Y N (If carer 2 is UoB staff) Will you be eligible to join the nursery salary sacrifice scheme for payment of nursery fees? Y N N/A 16. Expected course completion date or end of contract (if fixed term staff) dd/mm/yyyy If you are a student, (please circle) Undergraduate Postgraduate 17. Will you be a UoB staff member or student when your child will start at the nursery? Student Y N Staff Y N Further information (e.g. your start date): 18. Names and dates of birth of other children in family living at same address 19. I would like to apply for a nursery place to start from (dd/mm/yyyy) 20. Please indicate your nursery requirements in the table below (Note: Please indicate in the comments box if your requirements are flexible, e.g. any 3 days, no half days or Monday plus any other day, can be half days etc.) DAY AM LUNCH PM COMMENTS Monday Tuesday Wednesday Thursday Friday 21. Please tick your intended usage of the nursery: Full Year University Term Only Option only available to student parents Holidays Only 22. I declare the information on this form to be correct to the best of my knowledge: Your signature: Date:
UCT-ARUA COLLABORATIVE RESEARCH PROJECTS 2017 APPLICATION FORM PLEASE SUBMIT AN ELECTRONIC COPY TO LATIEFA JATTIEM () BY 15 JUNE 2017. NO LATE SUBMISSIONS WILL BE ACCEPTED. INSTRUCTIONS: All applicants need to complete sections 1-6 and 9 Sections to be completed ONLY when a PhD student is nominated at the time of the PI applying c. Please note that documentation requested should be appended to this application form and be clearly marked according to the numbers and titles of appendices as listed in the “Application Checklist” below SECTION 1: APPLICANT’S DETAILS Surname: First name: Title: Telephone number: Email: Department/ School: Position: Faculty: Staff number: Appointment status (refer to eligibility categories): Curriculum Vitae of applicant should accompany this application – maximum one page (attach as APPENDIX 1 to the application form) SECTION 2: DETAILS OF THE UCT TEAM A Surname: First name: Title: Telephone number: Email: Department and faculty: Position: B Surname First name Title Telephone number: Email Department and faculty: Position: C Surname First name: Title: Telephone number: Email: Department and faculty: Position:
All Access to HE Subject Specialist appointed by OCN London must be committed to implementing OCN London’s Opportunities Policy and Code of Practice. Completion of this application does not guarantee appointment as an OCN London Subject Specialist Moderator. We will review your application and, if successful, will contact you for a discussion about how we can involve you as a Subject Specialist Moderator. Completed forms should be returned to . PERSONAL DETAILS Title: First name: Last name: Home address: Work address: Post code: Post code: Contact number: Contact number: Email: Email: Preferred contact address/email (please tick) NB if no selection is made contact will be to applicant’s home address Home address/phone/email: Work REFEREES Please provide the name, title and contact information for two referees, one of whom must be your current or most recent employer. If you are selected as an External Moderator then we are obliged to contact at least one of the referees. REFEREE 1 REFEREE 2 Title/name: Title/name: Address: Address: Post code Post code: Contact number: Contact number: Email: Email: Relationship to applicant: Relationship to applicant:
Please tell us more your idea that you want to explore at artsdepot in our Creation Space. How do you plan to utilise the time, what do you want to achieve and where do you see this idea going. The research for your idea needs to work in the Creation Space, please reference the supporting information and image. Maximum 2 sides of A4. References:
A White English / Welsh / Scottish / Northern Irish / British Irish Gypsy or Irish Traveller Any other White background, please write in B Mixed / multiple ethnic groups and Black Caribbean White and Black African White and Asian Any other Mixed / multiple ethnic background, please write in C Asian / Asian British Pakistani Bangladeshi Indian Chinese Any other Asian background, please write in D Black / African / Caribbean / Black British African Caribbean Any other Black / African / Caribbean background, please write in E Other ethnic group Arab Any other ethnic group, please write in __________________________
A-8 Applicants Access to Electrical Tools/ Instruments NAME OF TOOL/ INSTRUMENT (eg. Insulation Resistance Tester) BRAND (eg. Megger) SERIAL NO. (eg. 100187) LAST DATE OF CALIBRATION (eg. 10th Sept, 2016) TOOL OWNERS NAME & CONTACT (Yeboah Atinga & 029xxxxxx)
(1) Budget Items (i.e. what the money will be spent on.) (2) This Grant Request Amount ($) (ex. GST) (3) Other Funding Amount ($) (ex. GST) (4) In-Kind Support - Estimate the dollar value of the in-kind support ($) (5) Source & Status of Other Funding or In-kind Support. State if confirmed or unconfirmed Example only: Printing and Promotion $1000 $2000 $500 ABC Council Confirmed Total: $2000 Enter text. text. Organisation taxation and banking details These details should be for the applicant or the auspice body accepting the grant on behalf of the applicant. Taxation details ABN: Is your organisation registered for GST? Yes No Is your organisation incorporated? Yes No
Please state your career achievement: Technical skills experience: Business skills experience: People skills experience: Leadership skills experience: CIMA-MIA Strategic Leaders Programme CIMA Student Information Part 3 What is your current job scope? Please tick below: CIMA’s practical experience requirements This is not part of my job I have done this before I do it monthly in my job
Number of students enrolled in the 2018 school year: You are required to attach a copy of your student enrolment list in English, including identified WACE students and their corresponding student reference number if applicable. Classes information Location address Code* Day/s of the week Year level Number of classes per year Hours of language instruction per class Average number of students per class Location address Code* Day/s of the week Year level Number of classes per year Hours of language instruction per class Average number of students per class Location address Code* Day/s of the week Year level Number of classes per year Hours of language instruction per class Average number of students per class *Codes: G: Government school C: Catholic school I: Independent school O: Own building Term dates Term From date: To date: Term 1 Term 2 Term 3 Term 4 Teacher information Qualifications
Are you a car YES/ NO* References Please refer to the guidelines for applicants and give details below of two relevant referees, one of whom, must be your current employer Name Name Position Position Working relationship and date(s) Working relationship and date(s) Company Name and Address Company Name and Address Postcode Postcode Tel No (day) Tel No (day) Email Address Email Address ** Cardiff Metropolitan University ** REFEREES WILL BE CONTACTED UPON THE IDENTIFICATION OF A PREFERRED CANDIDATE FOLLOWING THE INTERVIEW PROCESS Where did you see this post advertised? (If an advertisement, please state which newspaper and the date.) (continued overleaf) Date of Birth National Insurance Number Eligibility to Work in the UK Do you require a Certificate of Sponsorship under Tier 2 of the Points Based System to enable you to work in the UK? Yes / No* (*delete as applicable) Do you have any ‘unspent’ convictions within the meaning of the Rehabilitation of Offenders Act 1974 or pending cases? Yes No
Prefer not to say Maternity Leave: In the past year have you taken any maternity leave? (please tick the appropriate box) Yes No Prefer not to say Religion: What is your religion? (please tick the appropriate box - classifications in line with ECU) No religion Buddhist Christian Jewish Muslim Sikh Spiritual Any other religion or belief Prefer not to say Gay Heterosexual Other Prefer not to say Languages (please tick the appropriate boxes) Can you speak Welsh? Not at all A little Fairly well Fluently Prefer not to say Can you write in Welsh? Not at all A little Fairly well Fluently Prefer not to say Languages cont. Can you read Welsh? Not at all A little Fairly well
* delete as appropriate Education – Secondary Dates From To Name of secondary school attended Examinations taken, results obtained, distinctions Education – University/College – if appropriate (please attach copies of documentary evidence of qualifications) Dates From To Name of University/College attended Subjects studied Examinations taken, results obtained, class of pass scholarships/other distinctions Further Training Please provide details of Professional, Occupational or Technical training undertaken, including teacher training, apprenticeships, articles, and other courses. Dates From To Type of Training Subject/Skills College/Institute/ Place of study Qualifications Gained
Application for employment Data Protection Act 1988 The Royal College of Emergency Medicine may put the information you give on this form onto a computer system to help process your application. About the vacancy Vacancy applied for Personal details: Name Mr Mrs Miss Ms Other Please specify Surname Address Full daytime Full evening phone number phone number address Work history Start with your most recent job and work back. Continue on a separate sheet if necessary.
MONITORING INFORMATION NHS England and Health Education East Midlands are committed to a policy of equal opportunities. In order to monitor the effectiveness of this policy, applicants are asked to complete this monitoring form. These statistics are used solely for the purpose of monitoring and form no part of the selection procedure. The monitoring form will be separated from your application. Please tick the box which you feel describes your ethic origin. White – British White – Irish Other White Background Black or Black British – Caribbean Black or Black British – African Black Background Asian or Asian British – Indian Asian or Asian British – Pakistani or Asian British – Bangladeshi Chinese or Other Ethnic Background – Chinese Asian Background – White and Black Caribbean Mixed – White and Black African Mixed – White and Asian Mixed Background Other Ethnic Background Not Known Information Refused TO BE COMPLETED BY ALL APPLICANTS DISABILITY/SPECIAL NEEDS Please tick the box next to the statement which is most appropriate to you. You do not have a disability nor are aware of any additional support requirements in study You have dyslexia You are blind/partially sighted You are deaf/have a hearing impairment You are a wheelchair user or have mobile difficulties You need personal care support
Have you been awarded a prize or distinction for your academic work? Yes – please give details below No English Language Competence Is English your first language? Yes No Was English the language of instruction of your first degree? Yes No Was English the language of instruction in your place of employment? Yes No Do you hold a SELTS (Secure English Language Test) certificate at level B2 or above? Yes No If ‘Yes’ please provide details Name of test: Listening: : Writing: Speaking: Date certificate issued: Research Experience Do you have prior experience of qualitative and/or quantitative research? Yes – please give details below (course code / title / description / credits awarded / year of completion) No Have you undertaken any research training? Date course/module completed: Institution: Content of course/module: Have earned credits from any of your research training or experience? Yes – how many? No Please list any publications or any other evidence of research experience Employment Start Date End date Position held Name and address of employer Current Employment
Research degrees: opportunities and Higher Education Statistical Agency (HESA) monitoring form Please answer the following questions. This information will not affect your registration with The Open University. Surname or Family name: First Name(s): Date of birth: / / Gender: Male Female Other Country of Birth Place of Birth HESA number: A HESA number is issued to each higher education student in the UK. If you’ve studied recently at a UK university and already have one, please give it here I don’t know it Do you have a disability? The Open University uses the statutory definition of disability; ‘You're disabled under the Equality Act 2010 if you have a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities’. Yes No I prefer not to say If Yes, please provide further information: The University welcomes people with disabilities and we encourage you to tell us as early as possible of any requirements. We will only use this information to assess and arrange services to support you as a student. What is your ethnic origin?
Section 5 Education Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first: College or University Dates attended from and to Course Qualifications and grades obtained School Dates attended from and to Subjects Qualifications and grades obtained Continue on a separate sheet if necessary Professional, Registered or Management Qualifications Please give details: Professional/Registered/ Management Qualifications Course Details Continue on a separate sheet if necessary Section 6 Training and Development Please give details of any training and development courses or non-qualifications courses support your application. Include any on the job training as well as formal courses. Title of Training Programme or Course Duration of Course and date completed
Section 11 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 references are. Reference 1 Reference 2 Name: Name: Position (Job title): Position (Job title): Work Relationship: Work Relationship: Organisation: Organisation: Address: Address: Postcode Postcode Telephone No: Telephone No: E-mail: E-mail: Are you willing for this referee to be approached prior to the interview? Yes No Are you willing for this referee to be approached prior to the interview? Yes No
Application Form Course Introduction to Theatre Interpreting Date Saturday 13 October 2018 Contact Details Name Address Postcode Telephone Mobile About your qualification, registration and experience: What is your current BSL qualification and where did you study for it? Level 6 NVQ in BSL (or equivalent) Studying toward Level 4/6 NVQ in BSL Level 3 Certificate in BSL (or equivalent) Where? What is your current interpreting qualification and where did you study for it? I have completed an interpreter training course I am still studying on an interpreter training course I am not on an interpreting training course Name of qualification: Where? What is your current registration status? RSLI Trainee Interpreter Since when? Not registered (Please explain why) Are you a member of ASLI or VLP? No Yes – Membership number: General Details: How did you learn about us?
Please explain why you want to join this course and what your expectations are. What does “Theatre Interpreting” mean to you? Have you any previous experience of Theatre Interpreting (either amateur or professional?) Payment of course fees: Course Total Early bird (before 31 July 2018) £130 £ Standard Rate (after 1 August 2018) £145 £ Theatresign Interpreter Rate £65 £ Reminder: Your on the course is not confirmed until receipt of payment by Theatresign. Who will pay? Full amount must be paid before the first day of the workshop. If any problems, please contact us. Yourself Your employer Outside funding To be confirmed How will you pay? Please read the Payment Methods and Terms and Conditions on the following page. Cheque BACs (bank transfer) If your employer is paying for the course, please give details of your employer for invoicing Employer Contact name Address Telephone Email
Application Form Course Making It Visual (Level 3+) – London Date Friday 5 October 2018 Contact Details Name Address Postcode Telephone Mobile Email About your qualification, registration and experience: What is your current BSL qualification and where did you study for it? Level 6 NVQ in BSL (or equivalent) Studying toward 4/6 NVQ in BSL 3 Certificate in BSL (or equivalent) Where? What is your current interpreting qualification and where did you study for it? I have completed an interpreter training course I am still studying on an interpreter training course I am not on an interpreting training course Name of qualification: What is your current registration status? RSLI Trainee Interpreter Since when? Not registered (Please explain why) Are you a member of ASLI or VLP? No Yes – Membership number: General Details: How did you learn about us?
100-200 words. You may decide to complete this last. Project Name: ______________________________________________________________________ Project Financial Overview What is the budget of your project? _______________ Over how many years? ______ What is the TSC Stores Grant amount you are applying for? _____________ Over how many years? ______ If you are awarded your Grant request, when would you like to receive it? Month/Year _____________ Will persons having signing authority for your group sign a legal Undertaking? (Y/N) _______ Budget Please attach an estimated budget for your project.
NATIONAL LAW UNIVERSITY AND JUDICIAL ACADEMY, ASSAM (ESTABLISHED BY THE ASSAM ACT NO. XXV OF 2009) HAJO ROAD, AMINGAON, GUWAHATI – 781031, KAMRUP - RURAL, ASSAM (INDIA) APPLICATION FORM FOR REASEARCH ASSOCIATE ADVERTISEMENTPUBLISHED IN DATED FORM NUMBER (FOR OFFICE USE ONLY) …………………… PASTE YOUR RECENT PASSPORT SIZE PHOTOGRAPH HERE 1.NAME OF THE POST APPLIED FOR 2. PERSONAL DETAILS A. NAME (IN CAPITAL LETTERS) FIRST NAME MIDDLE NAME SURNAME B. DATE OF BIRTH DAY MONTH YEAR AGE AS ON DATE YEAR MONTH C. PLACE OF BIRTH CITY / VILLAGE STATE COUNTRY D. FATHER’S NAME E. MOTHER’S NAME F. NATIONALITY G. GENDER H. COMMUNITY/CATEGORY (TICK WHICHEVER IS APPLICABLE) I. MARITAL STATUS J. IF PHYSICALLY CHALLENGED, INDICATE THE RELEVANT PARTICULARS IF APPLICABLE, WRITE ‘YES’ PERCENTAGE OF DISABILITY (i) BLINDNESS OR LOW VISION (ii) HEARING IMPAIRMENT (iii) LOCOMOTOR DISABILITY OR CEREBRAL PALSY(INCLUDES ALL CASES OF ORTHOPEDICALLY HANDICAPPED)
AREA OF SPECIALIZATION MARKS (%) / CGPA INSTITUTION UNIVERSITY ANY OTHER EXAMS PASSED 4. WORK EXPERIENCE (INCLUDING CURRENT POSITION / EMPLOYMENT) DESIGNATION AND OF PAY NAME AND ADDRESS OF EMPLOYER(S) DATE OF JOINING DATE OF LEAVING LENGTH OF SERVICE NATURE OF WORKS / DUTIES I II
5. PUBLICATIONS, IF ANY (use separate page if required) PUBLICATIONS PUBLISHED (NO.) ACCEPTED /IN PRINT (NO.) SELF ASSESSMENT API SCORE (If applicable) VERIFIED API SCORE (If applicable) BOOKS RESEARCH PUBLICATIONS RESEARCH PUBLICATIONS (JOURNALS) NATIONAL MONOGRAPHS OTHER PUBLICATIONS 6. SEMINARS / CONFERENCES / WORKSHOPS / TRAINING PROGRAMMES, ATTENDED / ORGANIZED ETC. (attach additional pages or c.v., if required) IN INDIA (NO.) ABROAD (NO.) TOTAL (NO.) SELF ASSESSMENT API SCORE VERIFIED API SCORE 7. REFERENCES(ACADEMIC / PROFESSIONAL) (THREE) (WITH COMPLETE ADDRESS FOR COMMUNICATION) REFEREE – 1 NAME: DESIGNATION: ADDRESS: EMAIL: PHONE (LANDLINE) WITH STD CODE: MOBILE NO: FAX: EMAIL: REFEREE – 2 NAME: DESIGNATION:
Part 5: Student’s income Please complete where applicable Year Parents Learning Allowance/ Lone Parents’ Grant Adult Dependants’ Grant Childcare Grant Care Leavers’ Grant sabled Students’ Allowance (DSA) Net earnings Parental/Partner contribution Tax Credit Working Tax Credit Child Benefit Housing/Council Tax Benefit Income Support Jobseekers’ Allowance Professional/Career Development Loan Scholarships/Trusts/Grants (please specify) sability benefits (please specify) Other income including savings (please specify) Part 6: Student’s expenditure Please complete where applicable A Composite Living Costs Year Food/Household/Laundry Gas Electricity Water Telephone TV licence Contents insurance Council Tax Subtotal 6A B Other Living Costs Year Fees Rent/Mortgage Childcare costs Travel costs (home to institution) Travel costs (daily travel during term time) Private vehicle (road tax/fuel/insurance/maintenance etc) Books/equipment/course costs (including photocopying) sability costs not covered by DSA (please specify) Insurance (excluding car/ contents insurance) costs (please specify) Subtotal 6B Overall total (6A + 6B)
PART 4 – SUMMARY OF EVIDENCE Provide an overview of all key journal articles or research published in the public domain related to the proposed service that is for your application (limiting these to the English language only). Please do not attach full text articles, this is just intended to be a summary. Probably the best evidence for the use of SIR-Spheres Y-90 resin microspheres for Metastatic Breast Cancer is: Type of study design* Title of journal article or research project (including any identifier or study lead if relevant) Short description of research (max 50 words)** Website link to journal article or research (if available) Date of publication*** 1. Single-centre experience Saxena A, Kapoor J, Meteling B et al. Yttrium-90 radioembolization for unresectable, chemoresistant breast cancer liver metastases: A large single-center experience of 40 patients. Annals of Surgical Oncology 2014; 21: 1296–1303. Forty patients underwent resin-based Y90 radioembolization for unresectable, chemoresistant BRCLM in a single institution. All patients were followed up with imaging studies at regular intervals as clinically indicated until death. Radiologic response was evaluated with the Response Criteria in Solid Tumors criteria. Clinical toxicities were prospectively recorded. Survival was calculated by the Kaplan-Meier method. This study provides supportive evidence of the safety and efficacy. Listed on Pubmed 2014 Probably the best evidence for the use of SIR-Spheres Y-90 resin microspheres for Metastatic Neuroendocrine Tumours (NETs) is: Type of study design* Title of journal article or research project (including any trial identifier or study lead if relevant) Short description of research (max 50 words)** Website link to journal article or research (if available) Date of publication***
Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving: Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving: Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving:
Dates From: To: Name & address and type of school/establishment: Post held Salary details: description of duties: Reason for leaving: From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving:
Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving: Section 4 – Qualifications and Training Secondary Education (CSE, GCE, GCSE, RSA, A/AS level etc or other equivalent Date: (mm/yyyy) Examination type: Subject(s) – List in box Grade achieved – List in box GCSE: AS/A Level Other:
Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving: Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving: Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving:
Dates From: To: Name & address and type of school/establishment: Post held Salary details: Brief description of duties: Reason for leaving: Section 4 – Qualifications and Training Secondary Education (CSE, GCE, GCSE, RSA, A/AS level etc or other equivalent Date: (mm/yyyy) Examination type: Subject(s) – List in box Grade achieved – List in box GCSE: AS/A Level
Name of school/college From To Qualifications gained with date Higher Education Name and address of university, college and/or university education department Dates From To Full or Courses/subjects and passed Date of examination and obtained Age groups for which trained Professional Courses Attended as a Teacher time
Sexual orientation Please tick Bi-sexual Gay Lesbian 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 Disability Do you consider that you have a disability? Please tick Yes - Please complete the grid below No Prefer not to say My disability is: Physical Impairment Sensory Impairment Mental Health Condition Learning Disability/ Difficulty Long standing illness Other Prefer not to say Religion Please tick No religion Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim Sikh Any religion (Write in) Prefer not to say
Type of School and NOR (approx.): Responsibilities Held (if applicable): Reason for Leaving: Local Authority (if applicable): Additional Allowances (type/value): Pupil Age Range / Gender: Key Stage / Pupil Age Range Taught: Other Employment: Please give details of any other periods of employment you have undertaken which you have not included on page 4, starting with the most recent. Any gaps in your employment and/or training and education history will be explored with you if you are called for interview. Please use a continuation sheet if necessary. Employer’s Name and Address Dates Employed From and To (Month/Year) Position Held Salary and Benefits Reason for Leaving Periods When Not Working: