Rugby Enterprise Academy Application Form

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1 Where did you find out about this vacancy? Rugby Enterprise Academy Application Form Personal Details: Name: Date of Birth: Term Time Address: Title (Mr/Mrs/Miss/Ms): National Insurance No: Postcode: Home Telephone No: Mobile No: Please confirm preferred method of contact: Telephone / (please circle) Do you hold a Current Full UK Driving Licence? Work Permits: Under the Asylum & Immigration Act 1996, the Company has a responsibility to ensure that only those legally entitled to work and live in the UK are offered Employment. Do you require a work permit/visa to take up Employment in the UK? Yes / No (please circle) If yes, please supply work permit / visa details Expiry date: Availability for interview: Please include your expected return to University start date

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3 Personal Statement: Please detail below your reasons for applying to the Rugby Enterprise Academy. Please detail experience you feel would be relevant to a Premiership club. Previous Employment: Please provide details of your previous employment starting with your most recent. This should include any breaks in employment, unpaid or voluntary work which you may have undertaken. Please continue on a separate sheet if necessary. Dates of Employment Name and Address of Reason for Leaving Salary & Benefits Employer & Job Title

4 Education/Qualifications and Vocational Training: Please provide details of your education and training, giving current or most recent first: Secondary/Higher Education - Qualification Grade School/College/Training Provider (Please include name & address) Premiership Clubs: taking in to account re projects outlined, please detail which Premiership Club(s) would be your preferred choice and why. Also detail which Club(s) you would not be able to be allocated to for logistical reasons.

5 References: (please provide contact details of 2 referees) Name: Job Title: Company: Address: Name: Job Title: Company: Address: Telephone: Telephone: Please note - No references will be taken up until a provisional offer has been made. All offers are subject to satisfactory references, and you should be aware that as a result of an unsatisfactory reference, it may lead to the withdrawal of the offer of appointment. The Rehabillitation of Offenders Act 1974: Positions involving working with children and vulnerable adults are exempt from the above act and require an Enhanced Criminal Records Bureau (CRB) Check. This will be indicated in the advert. If you are applying for a position requiring a CRB check you must complete the following: Have you ever been convicted of a Criminal Offence? Do you have any pending charges? If you have answered yes to either of the above please provide details of the offence using the formal name of the charge, the date occurred and the sentence of the court.

6 Declaration: I certify that all the facts/details stated on this form are correct. I understand that the WRU reserves the right to verify all information contained in this application through the use of background checks before or after employment commences. I authorise the WRU to obtain references from any referees and all former employers and release the WRU and referees from any liabilities caused by giving and receiving information. I understand that my employment is contingent upon the accuracy of the information contained within this application and upon verification of my right to work in the UK. I may also be required to present a copy of my police record. Signed: Dated: Please return completed form to the Human Resources department hr@wru.wales or Human Resources, Principality Stadium, Westgate Street, Cardiff, CF10 1NS.

7 Equal opportunities monitoring form The WRU strives to operate a policy of equal opportunity and not to discriminate on the grounds of race, colour, religion, age, sex, nationality or disability with respect to employment, promotion or training. To help us monitor this, will you please provide the information requested. The information you provide will only be used for monitoring purposes. Ethnic Origin: A - White British Irish Any other British background (please specify) D Black or Black British Caribbean African Any other Black background (please specify) B - Mixed White and Black Caribbean White and Black African E Chinese or other ethnic group Chinese Any other (please specify) White and Asian Any other Mixed background (please specify) C Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background (please specify) F Arab or Middle Eastern descent Arab Northern African Iraqi Kurdish Any other Middle Eastern background (please specify) Nationality: British Age group (please circle): Under Prefer not to say Gender (please circle) : Male Female Prefer not to say

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