Application for Employment

This form has three parts: You must fill out Part 1 to provide the information we need to consider your application. We only need you to fill out Part 2 for posts where we have to carry out additional screening procedures. You should only fill it in if we have told you that it needs to be completed. Part 3 is optional but if you fill it out it will help us to make sure that our equal opportunities policy works and that we are advertising in the right places. It will also give us some information that we will need if we employ you. We will separate this part from the rest of the form when we get it. We will not use it as part of the selection process. If you are successful, we will keep your application form. If you are unsuccessful, we will destroy it no later than twelve months from our decision not to employ you. Position applied for Department Vacancy reference Applicant reference (office use only) Administrative Supervisor Wolfson Brain Imaging Centre SR00661

PART 1
PERSONAL DETAILS
Last name First name(s) Title Current address Post code Jason Wakefield Mr 2 Hinton Avenue Cambridge CB1 7AS 01223 246244 7867618323 avellopublishing@yahoo.co.uk Do you already have the legal right to work in the UK? Yes No If yes, please write in any conditions (e.g. end date, Visa type):

Home telephone Mobile telephone E-mail address Immigration status

UK National Insurance number (where held)

We offer this application form in alternative formats which can be provided by the department which you are applying. CHRIS/5, Version 4, 27/04/2012 University ofto Cambridge Application for Employment Part 1, Page 1 of 5

EDUCATION, QUALIFICATIONS & TRAINING

GCSE and Equivalent Education We do not need full details of your GCSEs (or equivalent qualifications). Please tick the relevant boxes below and give the total number of other GCSEs (or equivalents) at grades A*-C. Please use the Other details section of the table to give any other information about your GCSEs which is relevant, for example, if you have a GCSE in a subject that is particularly relevant to this job or if you have overseas qualifications. Please note that you may be required to produce qualification certificates if you are invited to attend an interview. I have an English Language GCSE (or equivalent) at grade A* to C I have an English Literature GCSE (or equivalent) at grade A* to C I have a Mathematics GCSE (or equivalent) at grade A* to C I have one or more Science-based GCSE(s) (or equivalent) at Grade A* to C The total number of GCSEs (or equivalent) I have at Grade A* to C is Other details of GCSE and equivalent education Yes Yes Yes Yes 6 No No No No

Education Above GCSE Level and Training Starting with the most recent, please give details of your education above GCSE level and any training which is relevant to your application. We may ask you to produce qualification certificates if we ask you to come to an interview. Place of learning Anglia Ruskin University Cambridge. Anglia Ruskin University Cambridge. Open University Start date 2009 End date 2010 Qualification level (if applicable) Subject Grade (if applicable) Pass 2:1

MA (Hons) BA (Hons)

English Literature English Literature

2005

2008

2004 2004 2003

2005 2004 2004

60 Credits Level 1 ECDL Key Skills certificates Social and Life Skills Certificates

Humanities F.A Coaching Certificate European Computer Driving Licence Communication Information Technology -Introduction to small business -Budgeting and Money Management

Pass Pass Pass Level 2

Milton Keynes. Bolton Wanderers F.C City College Manchester. City College Manchester. City College Manchester.

2003 2003

2004 2004

Level 1 Level 1 Level 2

2002
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2003

Pass
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University of Cambridge Application for Employment

British Weight Lifters

Association.

Leaders Award

B.W.L.A Leaders Award

Professional Body Membership Please give details of any professional body membership which you hold. Professional body Membership level Start date

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CAREER HISTORY
Starting with the present, please give details of your full career history. As well as employment, please include any periods of voluntary work, travel, career breaks and unemployment. If you have worked for the University before, we may ask the relevant department about your employment record. Start date 2011 End date 2012 Employer Job title Key responsibilities Reason for leaving or notice period (where applicable) I only speak English the role requires fluency in several languages.

Avello Publishing

Editor in Chief

My current achievements include developing the Avello academic journal in to an international business operation. Management of the Professors on the international editorial board. Acute strategic thinking and entrepreneurship. The ability to work constructively with colleagues. Strategic analysis and planning. My successes are in critical negotiations and managerial innovations. My several years of management experience has involved a primary responsibility for large numbers of people, public speaking and media speaking. This has included experience including attending government trade / investment conferences and international, private-sector industry workshops. Responsibilities included overseeing efficient communication, critical decision making, management and execution of the aforementioned decisions. The communicator role involved the press and the rest of the outside world via email, as well as organizing employees with mobile phone calls. The decision-making role involved problem solving through changing policies, strategies and motivating employees or colleagues within the organization's events. While studying full time, one worked for the English

2009

2010

Funky Bubblers Entertainment

Corporate Officer

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2008

2009

Anglia Ruskin University Cambridge

Public Relations

department of Anglia Ruskin University on open days. This was a public relations role involving welcoming prospective undergraduate / postgraduate students and promoting my department. Such work helped me to develop skills in customer service and marketing. This work evolved in to organising corporate and social events for friends and family of students enrolled on degrees at Cambridge University. I have been teaching English as a foreign language to international students studying in various institutions in Cambridge to prepare them for potential entry in to Oxbridge higher education. I was self-employed in this capacity and offered private tuition.

2007

2008

Private Tutition

Private Tutor

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SUITABILITY FOR THE ROLE

Please review the requirements of the role and provide evidence of how you meet these, using specific examples. My work experience and skills are perfect for providing comprehensive support and motivation for the Business Manager, Senior Accounts Clerk as well as Head of Department or other senior colleagues. Now my Masters degree is complete and I have significant experience in administration, financial operations and H. R, one hopes to find employment in a challenging, conglomerate environment or a world-leading University. Equipped with a post-graduate qualification, work experience in education and marketing, a lot of enthusiasm and well developed communication skills, my belief is that these attributes can make an excellent contribution to your organisation. Praise that testifies to my skills, abilities, character and achievements thus far have come from Drew Faust, President of Harvard University, USA and The Rt Hon Micheal Gove MP Secretary of State for Education, England.

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REFERENCES
Please provide details of two people (not relatives or friends) who will each provide an employers reference. One of these referees must be your current or most recent employer. If you do not have a current or recent employer, please provide details of your lecturer/course tutor/unpaid work employer etc. First reference Name Position Address: Telephone number E-mail address Can we contact this referee before the interview? Second reference Name Position Address Telephone number E-mail address: Can we contact this referee before the interview? Rowland Wymer Head of Faculty
East Road, Cambridge, CB1 1PT

0845 196 2041 rowland.wymer@anglia.ac.uk

Yes No

Eugene Giddens Professor

East Road, Cambridge, CB1 1PT

0845 196 2965 eugene.giddens@anglia.ac.uk

Yes No

APPLICANT DECLARATION & DATA CONSENT

The information which you have provided in Part 1 of this form will be used to process your application. It will not be passed to third parties or used for other purposes, other than those stipulated in Parts 2 and 3 of the form. Security procedures are in place for protecting your data in accordance with the principles contained in the Data Protection Act 1998. Your details may be stored electronically in a password protected system and/or as paper copies in a secure cabinet. Please read the statements below and then sign and date to confirm your acceptance of them. I confirm that I have read and understood the information above. I confirm that the information I have given in this application for employment form and any supporting documents is correct and complete. I understand that failure to disclose any relevant information or the provision of false information may lead to dismissal and subsequent termination of contract of employment. I understand that the University of Cambridge may carry out a verification process and may check all or any of the information provided on the application form, given in references and presented as proof of identity. I understand that an appointment, if offered, may be subject to a satisfactory medical examination and/or satisfactory completion of other pre-employment checks. If I have been required to submit Part 2 as part of the application process, I understand that the University of Cambridge will verify the information given in Part 2, which might include referral to an appropriate third party for purposes of security clearance. Jason Wakefield 07/11/12
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Signature Date

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PART 2
INFORMATION FOR ADDITIONAL SCREENING PURPOSES (SELECTED APPLICATIONS ONLY)
For some jobs, we have to make extra checks to ensure that applicants are suitable and/or that it is legal for us to employ them. If such checks apply to this job then we will have asked you to complete one or more sections of Part 2. Do not complete any section of Part 2 unless we tell you that you must. If you are not clear about what you have to do, please ask the department to which you are applying.

Section A: for selected applications PERSONAL DETAILS

Maiden name (if applicable) Date of birth Place of birth National Insurance number Nationality Passport no. and issue date Driving licence number

PERSONAL REFEREES
Please complete the contact details for two referees who have known you in a personal capacity over the last five years. First reference Name Position Address Telephone number E-mail address How long have they known you? In what capacity have they known you? Do we have permission to contact this referee before the interview? Yes No

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Second reference Name Position Address Telephone number E-mail address How long have they known you? In what capacity have they known you? Do we have permission to contact this referee before the interview? Yes No

PREVIOUS ADDRESSES
If you have lived at your current address for less than 5 years, please give details of all addresses for the previous five years with dates below. Please continue on additional sheet if required. Previous address 1 Address Dates you lived at this address Previous address 2 Address Dates you lived at this address From __/____ to __/____ From __/____ to __/____

ADDITIONAL CHECKS
I consent for an external security screening service, if required, to conduct checks necessary to progress my application and to provide the results to the University of Cambridge. Signature: Date:

I authorise the Driver and Vehicle Licensing Agency to supply any information it holds on its driver computer record about my driving entitlement, past and present, to the University or an external security screening service. This includes any valid endorsements and disqualifications (within the meaning of the Road Traffic Offenders Act 1988) and excludes any medical information. Signature: Date:

I authorise the United Kingdom Passport Agency to supply any information held in its records regarding the details of my passport submitted with this application to the University or an external security screening service. Signature: Date:

Section B: for applications to posts working with children and vulnerable adults or to security-sensitive areas
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If you are applying for a job in security-sensitive area or which involves working with children or vulnerable adults, you will normally be required to undergo a Criminal Records Bureau (CRB) check and/or register with the Independent Safeguarding Authority (ISA). Any sensitive information received by the University from you or an external agency during this process will be treated in confidence and will not be used unfairly against you. If you are required to have a CRB check, the post you are applying for is exempt from the provisions of the Rehabilitation of Offenders Act 1974. This means that you must disclose all criminal convictions found against you (spent and unspent) and any pending hearings. If the role you are applying for involves the opportunity for contact with children and/or vulnerable adults or their sensitive records, you must inform us if you have been barred from working with either or both of these vulnerable groups. The University promotes equality of opportunity for all, as stated in our Equal Opportunities policy, and the information which you disclose to us about any convictions, pending hearings and so on against you will not automatically prevent you from being appointed (unless required by law). Information that you disclose to us may be discussed with you further if you reach the short-list stage of the process. If you fail to disclose information that is subsequently revealed by a CRB check and/or ISA registration process, this could result in any conditional offer of employment being withdrawn and/or your referral to the ISA. Any information disclosed to us by the CRB/ISA will be discussed with you. Have you ever been (i) cautioned (ii) convicted of a criminal offence or (iii) do you have any hearings pending? Yes No

If YES please provide further information:

If you are required to register with the ISA in order to be appointed in the post you are applying for, please indicate below if you are already registered. Are you already registered with the ISA? Yes No

If YES please complete the following: My ISA registration number is: I consent for the University of Cambridge to use this number to verify my ISA registration status on the ISAs online checking facility. Signature: Date:

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PART 3
MEDIA AND EQUAL OPPORTUNITIES MONITORING (OPTIONAL)
The University is an equal opportunities employer and is committed to treating all job applications on their merits. We will use the information collected from this optional part of the application for statistical and monitoring purposes so that we can make sure that our equal opportunities policy is working. We will separate this part from the rest of the form when we get it. We will not use it as part of the selection process. Sensitive information will be used by the University to generate anonymised statistics which will never be presented in a form that allows individuals to be identified. We will record your sensitive personal information on our HR computer system. This system is password-protected and only trained staff have access to it. Only a limited number of key Human Resources, Payroll and Management Information Services staff can view information on disability, ethnic origin and nationality, and they will treat it with the strictest confidence. We will have to know your gender and date of birth in order to make sure you pay the right amount of tax and National Insurance contributions. We also use your date of birth to work out your expected date of retirement. If you choose not to provide information on your gender and date of birth now, we will ask you for it again upon appointment. We will record this information on our HR computer system and only a limited number of trained staff in your prospective department will be able to access it, in addition to the staff described in the paragraph above. If you are appointed, we have to provide some of the information in this part of the application to the Higher Education Statistics Agency (HESA http://www.hesa.ac.uk/) without your name being associated with it. Vacancy reference Post title Applicant reference (office use only) Advertising Source Where did you first learn about this vacancy? Gender What is your gender?

Female Male Prefer not to say __/__/____ Prefer not to say

Date of Birth What is your date of birth?

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Nationality Which country defines your national identity? Ethnic Origin

Country: Prefer not to say

HESA tells us what categories we have to use when we collect ethnicity data. In addition, the Equality and Human Rights Commission recommends these categories. Our use of these categories does not mean that the University thinks that they are the most appropriate. What is your background? White: British Irish White background other Mixed: White and Black Caribbean White and Black African White and Asian Mixed background other Asian or Asian British: Indian Pakistani Bangladeshi Asian background other Black or Black British: Caribbean African Black background other Chinese: Chinese Arab Arab Other ethnic group: Other ethnic group Prefer not to say: Prefer not to say

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Disability HESA tells us what categories we have to use when we collect disability data. Our use of these categories does not mean that the University thinks that they are the most appropriate. Do you regard yourself as in any way disabled? If yes, what is the nature of your disability? Yes No Prefer not to say Please tick the appropriate box. If you experience more than one type of impairment, please tick the box next to all of the types that apply. If your disability does not fit any of these types, please tick other. Specific learning disability (such as dyslexia or dyspraxia) General learning disability (such as Downs Syndrome) Cognitive impairment (such as autistic spectrum disorder or resulting from head injury) Long-standing illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy Mental health condition (such as depression or schizophrenia) Physical impairment or mobility issues (such as difficulty using arms or using a wheelchair or crutches) Deaf or serious hearing impairment Blind or serious visual impairment Other type of disability

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