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Membership of Technical or Professional Organisations

___________________________________________________________

Date of Admission

Grade of Membership

Name of Institute/ Professional Organisation

Method of Membership e.g. by examination, experience

Further information

_________________________________________________________________________________________

Are you related to any senior officer of

Yes

No

If Yes, please give details (Canvassing

West Berkshire Council?

will disqualify an applicant)

Do you hold a current driving licence?

Yes

No

Do you have any licence endorsements?

Yes

No

If Yes, please give details

**If Yes, please give details in an additional word document and email with this application. NOTE: You are not required to give any information on “spent” convictions under the Rehabilitation of Offenders Act 1974 unless the post is exempt in which case a Rehabilitation of Offenders Act declaration form will be attached for completion

Are you a car owner?

No

Yes

No

Have you any “unspent” criminal convictions? **

Yes

Referees __________________________________________________________________________________________________ Please provide details of two referees, which must be your present and previous employer. If you have not had two employers you may give details of someone who knows you well, although not a member of your family. If you have recently finished education, please give details of a tutor. It is important that you state a contact name, full postal address and at least one contact number, as incomplete details may delay your application. Please note that in addition to your two referees, we reserve the right to contact any of your previous employers for the purpose of verifying your employment record, if we think this necessary.

Referee 1

Referee 2

Name Position Address

Postcode Telephone Number (Daytime) Telephone Number (Home) Telephone Number (Mobile) Fax Number Email address Relationship to you

Do you wish to be contacted before we approach this referee?

Yes

No

Yes

No

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