APPLICATION FORM 					CONFIDENTIAL

Post Applied For:	Media & Public Relations Officer for Jean Lambert MEP

Reference:		JL012016

Please email this completed form to application@jeanlambertmep.org.uk.
You will receive an email acknowledgement.

If you cannot email your application, you can post a printed copy to: 
Office of Jean Lambert/Green MEPs (JL012016)
CAN Mezzanine
49-51 East Road
London N1 6AH

All applications to be received by Wednesday 3 February 2016 (GMT, midnight)

Please read carefully all instructions before completing this form.  
Please use dark type (or dark ink) as it will be necessary to make copies of your application.  
Please do not send a CV as it will not be looked at.

1.	SURNAME:

	OTHER NAMES:

2. 	HOME ADDRESS in full and telephone numbers (work and home):

3. 	a)  Please provide a telephone number and email address where we can contact you personally.

	b)  Where did you see this vacancy advertised?

4.	Are you subject to any conditions relating to your employment in the UK?

		If YES, please give details:

5.	If you were selected, when could you start?  Please give periods of notice if applicable:

6.	Please use the space below to tell us of any disability or health issues for which we may need to make reasonable adjustments to our test/interview selection process (for example, a hearing induction loop) if you are short-listed.

EDUCATION/QUALIFICATIONS (including any examinations which you are about to take or are awaiting results):

a.	SECONDARY EDUCATION

NAME OF SCHOOL 		DATES		QUALIFICATION 	SUBJECT	    	   GRADE
OR COLLEGE					e.g. GCSE/A-level    	

b.	HIGHER EDUCATION

NAME OF INSTITUTION  				DATES			QUALIFICATION	GRADE

OTHER RELEVANT COURSES AND TRAINING, INCLUDING IT

EMPLOYMENT HISTORY 
(including voluntary or unwaged work)

Name and Address		Dates		Job Title with a brief description of duties
							and responsibilities					

Please continue on a separate page if necessary.

REASONS FOR APPLYING FOR THIS POST
Before completing this section, please read the job description and key requirements for this post carefully.  Use this section to indicate how far your achievements, personal qualities, life experience, knowledge and skills match the key requirements for the post.  You may include paid and unpaid work, work within the home and leisure interests in your statement.

Please continue on a separate page if necessary.

REFEREES
Please give the name, address and telephone number of two professional/associate referees.  One should be you current/ latest employer.  Applicants leaving full-time education should give appropriate academic referees.

FIRST REFEREE

Name:

Position:

Organisation/Company:

Relevant dates:

Address and postcode

Tel:
Email:

SECOND REFEREE

Name:

Position:

Organisation/Company:

Relevant dates:

Address and postcode:

Tel:
Email:

DECLARATION

I hereby declare that the information I have given is accurate and complete:

Signature of Applicant:						Date: