zilongwang/ReadingBank huggingface dataset:
Darwin Darwin Corporate Park Ground Floor, Building 3 631 Stuart Highway Berrimah NT 0828 GPO Box 9800 Darwin NT 0801 t (08) 8982 1700 f (08) 8982 1725 Toll free 1800 193 111 e territory.businesscentre@nt.gov.au Katherine Shop 1, Randazzo Building 18 Katherine Terrace Katherine PO Box 9800 Katherine NT 0851 t (08) 8973 8180 f (08) 8973 8188 e Tennant Shop 2, Barkley Cnr Davidson and Paterson Street Tennant Creek PO Box 9800 Tennant NT 0861 t (08) 8962 4411 f (08) 8982 1725 e Alice Springs Ground Floor, The Green Well Building 50 Bath Street Alice Springs PO Box 9800 Alice Springs NT 0871 t (08) 8951 8524 f (08) 8951 8533 e
APPLICANT FULL NAME: POSTAL ADDRESS: POSTCODE: TELEPHONE NO. EMAIL: PLEASE STATE YOUR RELATIONSHIP TO THE PERSON TO WHOM THE CERTIFICATE RELATES: DETAILS OF MARRIAGE CERTIFICATE REQUIRED FULL NAMES OF BOTH PARTIES AT THE TIME OF THE MARRIAGE FIRST PERSON’S FORENAME(S): PERSON’S SURNAME: SECOND PERSON’S FORENAME(S): SECOND PERSON’S SURNAME: DATE OF MARRIAGE: PLACE OF MARRIAGE*: *Please specify name of venue, register office, church or building and locality. CERTIFICATE REQUIREMENTS PLEASE CIRCLE NUMBER OF CERTIFICATES REQUIRED: 1 2 3 4 5 6 PLEASE TICK THE SERVICE REQUIRED: Priority one working day service posted first class to UK address first copy £23.00 additional copies £10 each Priority one working day service posted recorded delivery1 to UK address first copy £24.00 additional copies £10 each Priority one working day service posted special delivery next day1 to UK address first copy £32.00 additional copies £10 each Priority one working day service posted to an overseas address first copy £24.00 additional copies £10 each Standard five working day service posted first class to UK address first copy £11.00 additional copies £10 each Standard five working day service posted recorded delivery to UK address first copy £12.00 additional copies £10 each Standard five working day service posted to an overseas address first copy £12.00 additional copies £10 each 1 Recorded and special delivery services require someone to be present to sign for the delivery. PLEASE STATE THE REASON FOR YOUR APPLICATION: Passport application Legal proceedings (e.g. pension, divorce, insurance) Job/Recruitment application Benefits claim Driving Licence Death related School Replacement Family history research Personal Travel Bank Account Other (please specify) FOR OFFICE USE ONLY Date of application: Reference number: Register/entry number: Certificate number(s): Date dispatched: Notes:
Name of person: Name of company: Postal address: Telephone: Fax: Email: What is their role: Small Business Operator Agent Solicitor Other (specify) If interpreter is required, which language: Respondent’s Details (the other company / person / agency) Respondent Name of company / person / agency Include ABN / ACN if applicable Does respondent have an agent? Name of the agent representing the respondent (company and person) Yes No Does respondent have a solicitor? Name of the solicitor representing the respondent (firm and person) Yes No Please provide full contact details for the other side Who is the best person to contact to discuss this application on behalf of the respondent side)? Name of person:
Please turn over Your Ground Name & location of ground. Who owns the ground? Pitch Dimensions (Metres) Is the pitch in a self-contained location or is it part of a larger complex? Self-contained/Complex Is your pitch a grass pitch? Yes/No If answer to above is ‘No’ what is it? Does your pitch have floodlights? Yes/No If answer to above is ‘Yes’ what is the average lux level of the lights? Have you enclosed written confirmation from the owner of the ground to the effect that your Club has either sole use or first preference user status of the ground at no more than four days notice? Yes/No If answer to above is ‘No’ when will this be available? Is the ground enclosed such that spectator access can be controlled? Yes/No Does the pitch have a protective barrier on all four sides separating spectators from the playing surface? Yes/No Current Full Member Clubs Application proposed by (Club) Football Club Signed Secretary Date Application seconded by (Club) Football Club Signed Secretary Date Applying Club Signed on behalf of Football Club Secretary Date
APPLICATION FOR MEMBERSHIP OF EASTERN REGION TENNIS Inc. A0031930C ABN 95 114 479 848 We the Committee of - …………………………………Tennis Club desire to become a Member of Eastern Region Tennis Inc. In the event of our Application being accepted, we agree to be bound by the Rules of the Association that are in force at the time of this application. PRESIDENT – (Block letters) Name …………………………………………………………. Email Address ……………………………………………….. Phone/Mobile ………………………………………………… Signed …………………………………………… SECRETARY – (Block letters) Name ………………………………………………………….. Email Address ………………………………………………… Phone/Mobile …………………………………………………. Signed …………………………………………….. TREASURER – (Block letters) Name …………………………………………………………… Email Address …………………………………………………. Phone/Mobile ………………………………………………….. Signed ………………………………………………. Please fill out the following Club details – Postal Address (P.O. Box if applicable) …………………………………. ………………………………………………………… Post Code ……... Email Address …………………………………………………… Bank details - BSB ……………….. Account ………………….
Signature: ______________________________________________________ Date: __________________________________________________________ What will you do with my data? We need the information you share with us to manage our membership and to satisfy our legal responsibilities. We’ll keep it safe for as long as you are an active member. Your information is used to: Manage your membership including membership payment Communicate with you about opportunities and news We promise we’ll only share your information if: you ask us to the law requires us we carry out market research it’s in the public interest Don’t – we’ll never sell your data or share it for any other reason. Girlguiding Scotland is the registered data controller* for all our members’ personal information, both in the UK and around the world. Want to find out more about how we use your information – and your rights? Visit * The organisation that manages and looks after your data
Describe the location of the proposed activity including its natural and physical characteristics and any adjacent uses that may be relevant to consideration of the application. Describe the location of the proposed activity as it is commonly known and in a way that will enable it to be easily identified e.g.: street address; the legal description; name of any relevant stream, river or water body to which the application relates; proximity to any well-known landmark; and grid reference. Part II: Matter Lodged With the EPA Sections 145, 148 and 149ZB, Resource Management Act 1991 This part of the form reflects the information requirements of Form 16A of the Resource Management (Forms, Fees, and Procedure) Regulations 2003. Proposal Details Provide a list of the local authorities under whose administrative jurisdiction consent is required, and any staff members with whom the proposal has been discussed. Provide a description of the proposal to which the matter relates. This information accompanies: 1 or more of the following applications for a resource consent 1 or more of the following applications for a change to or cancellation of the conditions of a resource consent 1 or more of the following requests for the preparation of a regional plan 1 or more of the following changes to a plan proposed by the local authority 1 or more of the following variations to a proposed plan 1 or more of the following notices of requirement for a designation or to alter a designation 1 or more of the following notices of requirement for a heritage order or to alter a heritage order. Does the proposal relate to an activity that is part of a proposal of national significance in relation to which one or more matters have already been subject to a direction under section 142(2) or 147(1)(a) or (b) (please tick)?: Yes. No. If you have answered yes to the question above, please provide the following information to identify the matter for which a direction by the Minister has been made: Project name: EPA reference number: EPA Project Leader:
This Application Form reflects the information requested in Guideline 15 of the EBA Guidelines, for the purpose of assessing natural persons who have or propose to have a qualifying holding in an applicant firm. All applications must be typed. For each section, the applicant firm must answer all questions and must provide any information or documentation requested. In the event that a question does not apply, the applicant firm must provide an explanation as to why he/she considers this to be the case. All responses and documents provided must reference the relevant section of the Application Form e.g., a response to question 5.1 of Section 5: Details of Financial Position & Source of Funding for Participation in the Applicant Firm, should be included in a section titled Section 5: Details of Financial Position & Source of Funding for Participation in the Applicant Firm, with each question answered in sequence referencing the relevant question. For example: Section 5: Details of Financial Position & Source of Funding for Participation in the Applicant Firm 5.1(b) details on access to financial markets, including details of financial instruments to be issued; ……………………………. 5.1(c) information on the use of borrowed funds, including the name of the lenders and details of the facilities granted, such as maturities, terms, security interests and guarantees, as well as information on the source of revenue to be used to repay such borrowings; ………………………………… etc. For each Section where a separate document is requested, applicant firms should ensure that these documents, along with any other accompanying documents, are clearly marked and referenced in accordance with the relevant Section numbers as indicated in 5. above. Where possible, all responses to questions provided should be in MSWord (or equivalent) format rather than scanned versions. Please submit the completed form (and any separate sheets, if relevant) with the firm’s application for authorisation/registration. The Central Bank may process personal data provided by you in order to fulfil its statutory functions or to facilitate its business operations. Any personal data will be processed in accordance with the requirements of data protection legislation. Any queries concerning the
APPLICATION FORM FOR OFFICIALS TO OFFICIATE AT THE 2017 COMMONWEALTH FESTIVAL OF LIFESAVING DURBAN, AFRICA The Royal Life Saving Society and Lifesaving South Africa invite are calling for applications from volunteers to officiate at the 2017 Festival of Lifesaving, incorporating the Commonwealth Lifesaving Championships and the Lifesaving Challenge, to be held in Durban, South Africa, from Tuesday 8th August to Saturday 12th August 2017. Applications are invited from all suitable persons who wish to be considered for appointment for these Championships. If you wish to be considered, please complete this form and submit it to LSA Head Office by Friday 24th February 2017. Successful applicants will be advised by 10th March 2017. Officials are required for the following events: Tuesday 8th August Key Officials Meeting and Site Visit Team Warm Up Sessions Team Registration 11.00am-12.00pm 9.00am – 4.30pm 2.00pm – 4.30pm Wednesday 9th August Officials Meeting Team Warm Up Sessions 2.30pm – 4.30pm 9.00am – 4.30pm Thursday 10th August Pool Events (Heats and Finals) 8.00am – 6.00pm Friday 11th August Pool Events (Heats and Finals) 8.00am – 6.00pm Saturday 12th August Pool Events (Heats and Finals) 7.30am – 4.30pm All events will take at the Kings Park Pool except the Officials Meeting where the venue will be confirmed. Travel and accommodation expenses for all officials are to be paid for by the individual concerned. No such expenses are provided for by the Host Committee or the Royal Life Saving Society. APPLICATION FORM FOR OFFICIALS TO OFFICIATE AT THE 2017 COMMONWEALTH FESTIVAL OF LIFESAVING
Percentages of total annual inspections in the EGF which result in the detection of minor or major offences. Percentage of inspections resulting in the detection of offences exceeds either of the following: (i) 20% for minor offences; (ii) 10% for major offences. Differentiation between major and minor offences is yet to be finalised. In the interim, an overall compliance rate of less than 85% will be used as the trigger point. 2006/07 - 93% 2007/08 - 89% 2008/09 - 91% 2009/10 - 86% 2010/11 - 87% 2011/12 - 85% Number of Estuary General MAC meetings held each year Less than two meetings for each fishery held in a calendar year, unless otherwise agreed by the MAC - No longer applicable. The Estuary General MAC, like most other MACs, has not operated formally since late 2009 (although it was used as an informal consultation tool up until 2011), initially pending the outcome of an internal review of consultative bodies. Subsequently the Independent Review of NSW Commercial Fisheries Policy, Management and Administration (2012) examined, amongst other issues, the effectiveness of current commercial fishery consultation arrangements. Based on the Review recommendations, the MACs are to be replaced by non-statutory, issue- or task-based working groups reporting to the Executive Director, Fisheries NSW. Thus the performance indicator needs to be revised. Non-statutory industry and cross-sector working groups comprising Estuary General fishers and other stakeholders were established in 2011 and 2012 including an Eastern Sea Garfish Resource Planning Group, a Mulloway Resource Planning Group and a working group to discuss options for the future management of pipis in NSW. In addition, as part of the Independent Review of NSW Commercial Fisheries Policy, Management and Administration (2012), the Review Team held a number of regional port meetings, consulted with a broad range of commercial fishery shareholders individually or as groups, and established a Stakeholder Reference Group (comprised of commercial fishery shareholders from each fishery) which met in October and December 2011.
UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA , Plaintiff(s), vs. Defendant(s). ) ) ) ) ) ) ) ) ) ) ) ) Case Number: CERTIFICATE OF SERVICE I certify that on (date), a true and correct copy of this application for payment of unclaimed was served by first class United States Mail on: Office of the United States Attorney Northern District of California 450 Golden Gate Ave. San Francisco, CA 94102 and the following party(ies) who may have an interest in the funds pursuant to 28 U.S.C. §2042: Dated: SIGNATURE: PRINT NAME:
MESQUITE HOUSING DIVISION PHONE 972.216.6424 FAX 972.216.6429 SECTION 8 APPLICATION FOR RECERTIFICATION IF YOU OR A MEMBER OF YOUR HOUSEHOLD REQUIRES ASSISTANCE OR A REASONABLE ACCOMMODATION IN COMPLETING THIS APPLICATION AND/OR MEETING ATTENDANCE, PLEASE CONTACT YOUR COUNSELOR PRIOR TO THE MEETING DATE. NAME _______________________________________ ______________________ _________________________________ Please Phone Number Email Address ADDRESS ________________________________________________________________________________________________ Street City State Zip Code Household Composition – Please list all persons who will be living as part of the household. Use an additional page if necessary. *Participants are not required to disclose being disabled. However, benefits for disabled household members cannot be provided unless the participant discloses being disabled. Household Member Name First Mi Last ID or Drivers License # Social Security Number Relation to Head of Household Sex Race Birth Date (Including Year) Current Age Disabled (Y/N)* First / Last Name of Absent Parent HEAD OF HOUSEHOLD 1. Household Composition Cont’d.
Details of the relevant plant that forms the ancillary services load Changes to relevant plant that form the ancillary services load Provide the following information: Please increase the number of rows if required. Change type (add / modify / delete) NMI at installed site Confirm site is under ownership, operation and/or control of the MASP (Y/N) Postal code of installed site NEM Region DNSP or TNSP Device manufacturer Device model / version Device control box model / version Device size (kWh) Max raise capability (kW) = max (fast, slow and/or delayed) Max lower capability (kW) = max (fast slow and/or delayed)
SUMMER PROGRAM We offer the same scheduling in the summer as our school year program. Just sign up for the number of sessions you need—registration for summer is in the spring. Please check YES or NO to indicate your interest in any of our Summer Program sessions which run in 2-week increments from 6/17/19 to 8/23/19. Yes No DATES TO REMEMBER Dates Who What November 1, 2018 All returning families (priority placement) Application and $75 Registration Fee (non-refundable) due. Leave application and check in Fireside Room on the 2nd floor. Be sure to put the date and time on application. November 8, 2018 Church Members/Former Families Application and $75 Registration Fee (non-refundable) November 15, 2018 New Families registration Application and $100 Registration Fee (non-refundable) Spring 2019 FCAYC Office Welcome packets mailed to families Spring 2019 New Families (Families who have made a security deposit do not make another deposit) Your security deposit of one month’s tuition is due to secure your child’s spot (non-refundable). This will be applied to your last payment for the school year of your last year in the school. Security deposit will be forfeited if your child is withdrawn before the school year begins. Slot will be forfeited if not paid by due date. June 2019 All families All Child and Family Intake Forms due to FCAYC Office* August 2019 All families Contact FCAYC with any changes to family information* August 28, 2019 All families Monthly tuition payments start *Please mark your calendars! Comments: Does your child have special needs, receive Birth to Three services or have an IFSP or IEP? If so, please attach a copy if available and describe needs here: What is your child’s primary language? OFFICE USE ONLY Program: Registration Fee Paid Date: Check # # Of Days: Annual Tuition: Classroom: Monthly Tuition: Start Date: 1st Payment Due: Approved by Education Director: Date Approved:
Tobacco Control Act Please print in block letters. If there is insufficient space, attach extra sheets. All applicable questions must be answered and full particulars provided. Application for a Tobacco Retail Licence 1. Type of application This application is for a: Natural person (Sections 2a, 3, 4, 5, 6 and 8 of application) Natural persons in partnership (Sections 2b, 3, 4, 5, 6 and 8 of application) Corporation (Sections 2c, 3, 4, 5, 6, and 8 of application) Association (Sections 2d, 3, 4, 5, 6 and 8 of application) 2a. Applicant details – Natural Person Title Mr Mrs Ms Miss Surname Given name Residential / business address Postal address (all correspondence will be mailed to this address) Telephone Mobile Email 2b. Applicant details – Partnership Full name of each partner (if space is insufficient, please provide information as an attachment) 1. Title Mr Mrs Ms Miss Surname Given name 2. Title Mr Mrs Ms Miss Surname Given name 3. Title Mr Mrs Ms Miss Surname Given name 4. Title Mr Mrs Ms Miss
Darwin TBC Building 3, Darwin Corporate Park 631 Stuart Highway Berrimah NT GPO Box 9800 Darwin NT 0801 t: (08) 8982 1700 f: (08) 8982 1725 Toll free: 1800 193 111 e: Katherine TBC Shop 1, Randazzo Building 18 Katherine Terrace Katherine NT PO Box 9800 Katherine NT 0851 t: (08) 8973 8180 f: (08) 8973 8188 e: Tennant Creek TBC Shop 2, Barkly House Cnr Davidson and Paterson Street Tennant Creek PO Box 9800 Tennant NT 0861 t: (08) 8962 4411 f: (08) 8982 1725 e: Alice Springs TBC Ground Floor, The Green Well Building 50 Bath Street Alice Springs PO Box 9800 Alice Springs NT 0871 t: (08) 8951 8524 f: (08) 8951 8533 e:
Enrolment Services D105-2055 Notre Dame Avenue Winnipeg, MB R3H 0J9 Ph: 632-2508 FAX: 697-4738 Application for Use of Facilities Name of group or organization requesting facilities: Name of person in charge, who will be present at event: Billing/Mailing Address: City/Town: Prov.: Postal Code: Bus. No.: Home No.: FAX No.: Cel No: Area Required: θ Classroom θ Lecture Theatre θ Selkirk Lounge θ Gym θ North Gym θ Display Areas θ Prairie Lights θ Boardroom θ Other: Reason for use of Facility: Date(s) required: Time(s) required: Set-up requirements (specify): ______________________________________________________________________________________ Admission to be charged? θ Yes θ No Special liquor permit required? θ Yes θ No Parking required? θ Yes θ No If yes, applicant must email: Audio Visual required? θ Yes θ No If yes, applicant must call Media Services @ 632-2231. Satellite Conference Services? θ Yes θ No If yes, applicant must call Satellite Services @ 632-2376. (Please advise if videotape is required.) On behalf of the above named group or organization, I hereby apply for permission to use the facilities described and agree to all the Terms and Conditions outlined on the reverse side. I also understand and agree to follow all emergency procedures as outlined in attached brochures. Date: Signature: F O R O F F I C E U S E O N L Y Facility Assigned: Cost of Facilities $ GST: $ Total Cost: $ Application Approval: Room Allocations Coordinator Date of Approval Copies to:
θ Applicant θ Information Centre θ Recreation Services θ Prairie Lights θ Power House θ Marketing & PR θ Controller’s Office θ Food Services θ Bldg. Services θ Security θ Administration θ Media Services θ Parking Services θ Continuing Ed. θ Students’ Association θ TLTC – Video
3. Complete details of Publications (Attach documentary proof & list during 1st July’16 to 30th June’17) (Indexed in Scopus, Pubmed & Web of Science) (Case report, review article, commentaries, photoquiz, pictorials CM will not be considered) : 4. Average Impact Factor for all the Publications as per SJR Index : 5. Significant Relevance of the research work carried out during the year as reflected in the publications with principal findings (Attach two page write-up) : 6. Research received International National DPU Funding : Amount received Amount utilized 7 Average Citation index as per Scopus & Pubmed : 8 Patents Received - Successfully - : 9 Any other relevant information : Date: (Signature of the Faculty) Date: (Signature and Seal of the Head of the Department) Date: (Signature and Seal of the
EDUCATION HISTORY Including Schools/Colleges attended (Please complete in full with the most recent first) FROM (Date) TO (Date) SCHOOL/COLLEGE/ UNIVERSITY SUBJECT DATE Evidence of IT Skills IT Package used Detail of how you used the IT package What impact did it have
PREVIOUS EMPLOYMENT (Starting with most recent, explaining any gaps in employment) DATES FROM/TO (Most recent first, explain any gaps in employment) JOB TITLE MAIN RESPONSIBILITIES/ ACTIVITIES COMPANY, ADDRESS & CONTACT NUMBER REASON FOR LEAVING (Please expand boxes or continue on additional sheets if necessary) INFORMATION IN SUPPORT OF YOUR APPLICATION
8. Employment History cont. Name and address of employer from and to Position held and outline of responsibility Reason for leaving Full/ Part-time Pay/ benefits Referees Please give names and addresses of two referees. One should be your present or most recent employer.
Part 3 MRCOG Lay Examiner Application Form Please complete the form electronically, expanding the spaces accordingly. Personal information Title: First name: Surname: Address: Daytime telephone number: E-mail: Education and training Schools/college/university attended: Qualifications attained: From: To: Results: Professional training / qualifications and any other courses relevant to this role: From: To: Level: Employment history Current or most recent employment Employer’s name and address: Dates: Position held and duties: Salary: Previous employment
What is your contractual period of notice? Current Salary Reason for leaving this post Present education (if not currently in employment) Date commenced course Expected date of award Title of course Institution Employment - Record of all employment (excluding present post in chronology order) Dates (from and to) Name and address of employer Position, with outline of responsibilities Reason for leaving
Details of other activities, skills and interests: Present or most recent employment (if any) Position held ………………………………………………………………………………. Date of appointment ……………………………………………………………………… Date of leaving ……………………………………………………………… (if applicable) Employer’s name and address …………………………………………………………………………………………………. …………………………………………………………………………………………………. ……………………………………………………………………………………………….. ………………………………………………………………………….................................
Date Joined Institute/ Organisation of Membership (Where appropriate) Please give details of In-Service training relevant to your application and undertaken in the last three years. Dates Course Length Course Title Qualification obtained and date of Award Course Provider From To Title of present/most recent post:
Name, address and type of school/establishment: Telephone No: Name of LA/employing body: Date appointed: Date left: Age range taught: Number on roll: Permanent/temporary: Part/full time: Salary details (please give details of all allowances) Current gross salary: Allowances: Please list chronologically, starting with current or last employer. Please give a brief reason for leaving each post and an explanation for any gaps in employment. (Continue on additional sheet(s) if required) Title of post/type of experience Name and address of employer Numbers on roll Age taught Dates From To
the Program Committee/sub-committee includes paid staff and/or Management Committee/ Board members: do they have voting rights within the Program Committee/sub-committee? Yes No How is the Program Committee formed and for what duration? Elected annually Appointed for ______-year term How many program proposals were received in the past six months? __________ How many of proposals were approved and broadcast? __________ How does the licensee provide information to the general community on procedures for making program proposals? Please attach a copy of the application form for a program proposal. Attach responses as APPENDIX 12. Section 5: Does the licensee have the capacity (management, financial, technical and compliance capacity) to continue to provide the service? (paragraph 84(2)(d)) ACMA USE Management 13. Please provide copies of the following documents: current constitution or articles of association and certificate of registration diagram of the organisation structure, showing the / management committee and committees / subcommittees, as well as staff positions list of current members of the board / management committee, indicating the term of each member minutes of the last two AGMs and most recent annual report membership application form, showing membership categories and schedule of membership fees list of positions—please specify paid (salaried and commissioned) and unpaid (volunteer) positions. Attach documents as APPENDIX 13. Is the licensee a member of an industry group? Yes No If Yes, name of industry group/s: ____________________________________
State, in order of date, where you have been employed (Your present post should be included as the first entry) Type of School (e.g.: Ind. Comp. 11-16:11-19) and Role From (date) To (date) Salary (e.g. Pay Point, Resp. Allowance) Nature of Role and Responsibility Reason for leaving 6. Qualifications Please list all training and qualifications which are relevant to this post including ‘A’ Level or equivalent, and equivalent professional qualifications. Course and main subject Certificate/Qualification (if any) Dates Where obtained
Freshfield Nursery School Application Form 2 Year Olds PUPIL SURNAME DATE OF BIRTH MALE/FEMALE FIRST NAMES Preferred Name: PUPILS ADDRESS AND POSTCODE CURRENT OR PREVIOUS SCHOOL NAME OF PARENTS WITH PARENTAL RESPONSIBILITY TITLE FORENAME SURNAME TELEPHONE NO EMAIL ADDRESS ADDRESS IF DIFFERENT FROM PUPILS’S ADDRESS IS YOUR CHILD LOOKED AFTER BY THE LOCAL AUTHORITY ? YES/NO ARE YOU ELIGIBLE FOR FREE 15 HOURS PLACE ? YES/NO Please see attached list of criteria ARE YOU IN RECEIPT OF AWARD NOTICE (TC-602) ? ARE YOU APPLYING FOR A PAID FOR PLACE ? DECLARATION I/We declare that the information given on this form is correct to the best of my knowledge and belief and authorise Stockport Council to make checks on accompanying information to support priority admission. I/We understand that any place offered to my child is based on the information given and may be withdrawn if circumstances are subsequently found to be other than those given. I/We will advise Freshfield Nursery School Headteacher in writing if there is any change from the details given on this form. SIGNED: DATE: PLEASE RETURN THIS FORM TO: HEADTEACHER FRESHFIELD NURSERY SCHOOL 42 MAULDETH ROAD HEATON MERSEY STOCKPORT SK4 3NB Who is eligible ? Families in receipt of non-working benefits Families with a total household income of less than £16,190. This will be recorded in your awards notice (see below).
Please indicate if you know any existing employees or Governors at King's Ely and, if so, how you know them. EDUCATION AND EMPLOYMENT HISTORY Please supply a full history in chronological (with start and end dates, giving months and years), of all training and further education, undertaken since the age of fifteen. PLEASE LIST ALL QUALIFICATIONS GAINED. PLEASE INDICATE ANY FOR WHICH YOU CANNOT PROVIDE ORIGINAL CERTIFICATION. Dates from & to, giving month & year Name and Address of Institution Course title & Awarding Body Qualification gained (including Date of Award
- INCENTIVES 2015-16 28 2015 Mr. / Mrs. / Miss/ Ms. First name Surname Land owner (if different from above) Postal address (If different from property address) Town / City Postcode Phone (A/H) Mobile Fax Email ABN (If applicable) Property details (where on ground works will be undertaken) Property name Property size (Ha) Property address (Where on ground works will be undertaken) Local Government area Lot and DP details (Where works will be undertaken. Available on your rates notice) Lot DP Which incentives are you interested in? Incentive type (please select) Incentive type Minimum requirements Ecosystem improvement
Open to all eligible land managers within the Central Tablelands LLS region. Farm management planning Blue Mountains Biodiversity Project Open to all eligible land managers within the Blue Mountains project area Project description Please describe your project(s), activities and what you are trying to achieve (refer to funding Fact Sheets; include approximate areas, distances, etc.) Have you had any Natural Resource Management funding by a government organisation? Yes No Details: If YES are these projects complete? Yes No Conflict of Interest Do you know of any Conflicts of Interest for funding eligibility? (E.g. employment in LLS, relationship to LLS staff member). Yes No Details: Keep up to date Would you like to be added to the Central Tablelands Local Land Services mailing list to ensure you don’t miss any future updates? Privacy Statement: CT LLS COMPLIES WITH THE PRIVACY AND PERSONAL INFORMATION ACT 1998 The information you are providing may be personal information under the Privacy Act. It is collected for the business purposes only of CT LLS and will not be disclosed to any third party except in accordance with the privacy policy of this organisation. You can request access to and correction of your personal information by calling the CT LLS on 1300 795 299. Information collected is a register of attendance required to fulfil our Duty of care and maybe used to contact participants for future meetings on the above topic Yes No
NB: It is essential that permissions for the following are secured in advance of this application being submitted for assessment: release of applicant to attend the five-day CfD counsellor training release of applicant to attend CfD supervision throughout the 12 week assessed practice period release of all CfD client material for use in supervision recording and release of selected CfD client material for assessment If a trainee is unable to meet the requirements for supervision and/or assessment, they will be withdrawn from the training programme. All applicants for this CfD counsellor training must ensure that: all sections of the application form are completed completed Line manager and supervisor statements are enclosed with the application form the application from arrives for selection no later than the given deadline date This NICE Recommended Counselling for Depression (CfD) training programme was designed and developed for delivery by British Association for Counselling and Psychotherapy in 2010 For further information: Counselling for Depression (CfD) counsellor training
PART C: RESEARCH, PUBLICATIONS AND ACADEMIC CONTRIBUTIONS For the following items use separate sheets(as Annexures) wherever required in the format indicated. All Annexures should be consecutively arranged and must bear your name and be authenticated with your signature. Please see Annexure - I at the end of this form for detailed instructions before filling this section. Published papers in Journals: S. No. Title with page Nos. and date of publication Journal Publisher Location ISSN/ ISBN No. Whether peer reviewed. Impact Factor, if any Source of Impact factor No. and name of Whether you are the First author Corresponding Author / Supervisor /Mentor B. (i) Articles/Chapters published in Books: S. No. Title with page Nos. and date of publication Book Title, editor & publisher ISSN/ ISBN No. Whether peer reviewed No. of Co-authors Whether you are the First author Corresponding Author / Supervisor /Mentor
Full Papers published in Conference Proceedings : S. No. Title with page Nos. and date of publication Details of Conference ISSN/ ISBN No. No. of Whether you are the First author Corresponding Author/ Supervisor/ (iii) Books Published as single author or as editor: S. No. Title with page Nos. and date of publication Type of Book & Authorship Publisher & ISSN/ ISBN No. Whether peer reviewed No. of Whether you are the main author C. Ongoing and Completed Research Projects and Consultancies (C) (i ) Ongoing Research Projects S. No. Title Agency Period Grant (Rs. Lakh) No. of Co-PI Whether you are the PI/Co-PI Total Received
(C) (ii) Ongoing Consultancies S. No. Title Agency Period Grant (Rs. Lakh) No. of Co-PI Whether you are the PI/Co-PI Total Received (C) (iii) Completed Research Projects S. No. Title Agency Period (Rs. Lakh) Whether policy document/ patent as outcome No. of Co-PI Whether you are the PI/Co-PI Total Received (C) (iv) Completed Consultancies S. No. Title Agency Period Grant (Rs. Lakh) Whether policy document/ patent as outcome No. of Co-PI Whether you are the PI/Co-PI Total Received
be used for monitoring purposes and will not be used in assessing 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. Ethnic group Workforce census code Please tick White WBRI British English Welsh Northern Irish Scottish WIRI Irish OOTH Traveller OOTH Gypsy WOTH Other White background Mixed MWBC White and Black Caribbean MWBA and Black African MWAS White and Asian MOTH Other Mixed background Asian or Asian British AIND Indian APKN Pakistani ABAN Bangladeshi CHNE Chinese AOTH Other Asian background Black or Black British BCRB Caribbean BAFR African BOTH Other Black background Other ethnic group OOTH Arab in: Prefer not to say REFU
OUTLINE the ways in which you feel this course will enable you to impact youth arts practice and policy in the non-formal education sector: Have you worked with young people in the non-formal education sector full time for 2 years or part time for 4 years (working as a youth arts practitioner counts) 2 YRS FULL TIME YES NO 4 YRS PART TIME YES NO PLEASE OUTLINE: OUTLINE any supports you may need to enable you to complete this course (learning, access, academic)
Name: Address: Telephone: Email: Name: Address: Telephone: Email: Name: Address: Telephone: Email: Section 3 continued Disability – Guaranteed Interview Scheme Under the guaranteed interview scheme disabled candidates who meet the minimum criteria for the role will be guaranteed an interview. By “minimum criteria” we mean that
Occupation Name and address of the institution your work in , or your scientific affiliation Position Office Address Office Post Address (City + Country) Tel. (country code, area code) ( ) Phone Fax Home Address Home Post Address (City +Country) Tel. (country code, area code) ( ) Fax Ω - End of Section I Section II – Details of your Research Work (Kindly fill out this section II for each research work) A - Title of Your Research Work Important: This item will be published in case the applicant is selected. Please refer to Laureates section in the website.
Please indicate if you know any existing employees or Governors at King's Ely and, if so, how you know them. EDUCATION AND EMPLOYMENT HISTORY Please supply a full history in chronological (with start and end dates, giving months and years), of all training and further education, undertaken since the age of fifteen. PLEASE LIST ALL QUALIFICATIONS GAINED. PLEASE INDICATE ANY FOR WHICH YOU CANNOT PROVIDE ORIGINAL CERTIFICATION. Dates from & to, giving month & year Name and Address of Institution Course title & Awarding Body Qualification gained (including grade) Date of Award
JOB APPLICATION FORM PLEASE CLEARLY IN BLACK OR BLUE INK Position Applied For: Site: PERSONAL DETAILS Title: Forenames: Surname: Address: Tel No: Mobile Number: Post Code: E-mail Address: EDUCATION & PROFESSIONAL QUALIFICATIONS Secondary School, College and University Dates Examinations taken Date Result From To Professional Qualifications currently held: how obtained, grade and date Other relevant Educational or Training Courses, with dates PRESENT POSITION
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1. Contact Details Title (Mr, Mrs, Miss) Name Home Address County Postcode Tel Mobile 2. Date of Birth 3. Qualifications 2.1 In which ecclesiastical parish do you live? Tick which applies. Bardsey with East Keswick Burton Salmon (Civil parish) Collingham with Harewood Ledsham with Fairburn Shadwell Thorp Arch None of the above 3.2. Did you attend a Lady Elizabeth Hastings C of E School? Tick applies. Collingham Dates……………..to………………. Ledston Dates……………..to………………. Thorp Arch Dates……………..to…….…………. None of the above
degree Total Marks must be written (b) University Education: Name and Place of Institution Name of Degree Passing Year Marks obtained / Total Marks CGPA Division % Age of Marks obtained must be written Subjects Note: Mention only those degrees which have been completed on or before due date. (c) Other Formal Training Education: Name and place of Institution Leaving Certificate OR Diploma obtained Years Attended Major Subjects From To (d) Academic Distinction: Name and place of School, College and University /Institution Certificate / Degrees obtained attended Distinction Certificate / Medal Major Subjects From To (e) Distinction in and Sports: ________________________________________________________________________________ 13. RESEARCH: Give particulars of all post-graduate and' independent research done, giving the name of the institution and the professor whom research was completed. 14. Give a list of all research papers published in scientific journals and attach originals or reprints. Only Research Papers accepted having DOI number or appearing on internet will be considered.
Dates From Dates To Position & W or P School or other Institution Responsibilities 4.2 Post(s) of Responsibility or Equivalent (start with the most recent and work backwards). Please indicate also if the post was Department paid (DES) school paid (SP) or voluntary (V). Dates From Dates To Position: P, DP, AP, SD, PC, DES, SP or V* School or other Institution Responsibilities *P = Acting Deputy Principal, DP = Deputy Acting Deputy Principal, AP = Assistant Acting Deputy Principal Post ; SD = Special Duty Post; PC= Programme Coordinator. DES = Department paid; SP = School-paid post; V= Voluntary post. 4.3 List, with outline dates, any extra-curricular activities in which you are or have been involved (start with the most recent and work backwards): 4.4 relevant experience (i.e. Social/Business start with the most recent and work backwards) Dates From Dates To Position Organisation Responsibilities
REF: AO/0218/ Job Title: Administration Officer (PT, 20 hours per week) (SI/023) All application forms should be emailed to or a signed hard copy returned to: The Monitoring Officer Sport Northern Ireland House of Sport 2a Upper Malone Road BELFAST BT9 5LA Grade: Administration Officer (AO) Salary: Hours : £18,946 - £22,291 (pro rata) PT 20 hours Closing Date: 5pm Tuesday 13 March 2018 Please ensure you read the ‘Information for Applicants’ booklet before filling out this application form. SECTION 1 - PERSONAL DETAILS Surname Forename Title Email Address Home address Postcode Telephone Numbers Home Work Mobile NI Number How did you hear about this vacancy? SECTION 2 – REFERENCES Please the names of three employment related referees, including your current employer. Reference 1 Name Address Telephone No. Position Reference 2 Name Address Telephone No. Position Reference 3 Name Address Telephone No. Position May SNI contact your present employer?
PROFESSIONAL ASSOCIATION MEMBERSHIP Please use an additional sheet if necessary Name of Professional Association Year of Membership Grade/level TRAINING Please give details of any training you have received or courses which did not lead to a qualification but which you feel are relevant to the post for which you are applying. Include any on-the-job training as well as formal courses. There is no need to mention any courses you have already listed in the section above Date attended (approx) Duration of Course Title of the training course or brief description EMPLOYMENT HISTORY Please give details of your employment history starting with your current or most recent employer and working backwards. Please account for any gaps in your employment history. If you have not worked before or if you have been out of work for some time, please use this space to describe how you have gained the relevant experience for your application. Please use an additional sheet if necessary Employer’s name, address and type of business Date employed month/year Job title, main duties and responsibilities Reason for leaving/salary
Country of Registration: Tools, Spare Parts & Accessories in GBP: £ Licence (of Home Country) (If insurance is required) What, if any, is the difference between the normal market value of your car type and the version you have prepared for the event? £ Claims History Please state details of any losses(including theft), whether insured or not in last 3 years for each driver including dates and costs for own damage/third party damage explaining circumstances – use a separate sheet if necessary. IF NONE, STATE NONE: Driver 1: Driver 2: Conviction History Please state any driving convictions for each driver, i.e, speeding, careless driving, drink/drug related offences etc. together with relevant fines / licence endorsements sustained within the last 5 years. IF NONE, STATE NONE: Driver 1: Driver 2: Please complete supplementary page provided for additional drivers / further details Travel Insurance/ Repatriation Declaration Have/are you or anyone to be insured on this policy 1. suffered from or received any ongoing treatment for any heart or cancer condition in the last five years? Yes No 2. currently receiving or have you received in the last 12 months, any advice, medication or treatment for any illness, injury or disease? Yes No 3. investigation or awaiting results for any diagnosed or undiagnosed medical condition? Yes No 4. travelling against your doctor’s advice, or for the purpose of obtaining treatment? Yes No 5. received a terminal prognosis? Yes No 6. on a waiting list for, or aware of the need for, any in-patient treatment? Yes No If you answered yes to any of the questions please provide further details below, stating which driver it applies too:
4 5 Value Bands £0 - 2k £2k - 50k Hours/Work Reactive Day Work: Normal Hours 8am – 5 pm Monday – Friday Emergency Reactive Day Work Normal day Hours 8am – 5pm (within 2 working hours) Monday – Friday Emergency Out of Hours 5pm – 8am and weekends Quotations and Tenders only and not Reactive/Emergency Day Work *Please see enclosed Shropshire Area Map on the next page.
If applicable, please describe the type of school including age range, number of pupils, boarding, day, co-ed etc.: Current salary and package: Notice period: Previous Positions – starting with most recent Dates of Employment Name and Address of Employer Job Title and brief summary of main responsibilities From mm / yy To mm / yy Reasons for leaving: Reasons for leaving: Reasons for leaving:
Address House number/name Town/city/ County Post code Employer’s email address Job Title Salary : Reason for Leaving : Main duties Employer Dates employed from - to Contact name for reference Address House number/name Town/city/ County Post code Employer’s email address Job Title Salary : Reason for Leaving : Main duties Employer Dates employed from - to Contact name for reference
Do you have a full current driving licence? (If required by the job description) EDUCATION Secondary Education School name/address From (MM/YYYY) To (MM/YYYY) Examinations (subject/result, etc.) (Tip: Tables will automatically expand as you type if extra space is needed) Further Education and Training University/college name From (MM/YYYY) To (MM/YYYY) Type of Course Subjects Qualifications or of degree Occupational Qualifications/Institute Membership/Membership of Professional Organisations College/Institute or other name From (MM/YYYY) To (MM/YYYY) Qualification/level EMPLOYMENT HISTORY Please provide details over the last 10 years, including any unpaid or voluntary work, listing present or most recent employer first. Any gaps in employment dates should be explained. If you have any particularly relevant experience dating beyond the last 10 years please include this. Current salary and benefits or salary when last employed: £ Notice required: