Fields marked with * are required.

Personal Details

Email *
Daytime Telephone Number *

If not a citizen of EEC, do you require a work permit?

Present/Most Recent Employment

Previous Employment




Position and Duties

Reason for leaving


Please include details and dates of any qualifications gained or being studied for or any courses and training programmes you have attended that are relevant to the job.




Examinations Passed

General Information

Act 1974 (minor motoring offences should be disregarded). The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the

References (present/most recent employer)

When may we request this reference?

When may we request this reference?

Additional Information


I declare that the information given in this application is true. I understand that any falsification of information in this application may result in disqualification from the recruitment process and if appointed could lead to dismissal.


Equal Opportunity Monitoring

Royal & Derngate strives to be an Equal Opportunities Employer. It aims to establish and maintain a working environment, terms and conditions of service and employment practices and procedures which will ensure that no job applicant, employee, actor or member of one of our groups/workshops receives less favourable treatment on the grounds of race, religion, belief, colour, nationality, ethnic or national origins, disability, gender identity, marital status, sexual orientation or age. We are also required by our principal funders to monitor ethnic origin, gender identity, sexual orientation and disability, and would be grateful if you would complete this form to enable us to do this. The information provided will be treated as strictly confidential. It will be used for monitoring purposes within the organisation and will assist us to make decisions that will ensure that we remain an Equal Opportunities Employer. Please note the categories and questions used are those recommended by the Office of National Statistics and the charity Stonewall.

Ethnicity: I would describe my ethnic origin as
Gender Identity:What best describes your gender?
Is your gender identity the same as the sex you were assigned at birth?
Sexual Orientation*
Age Range*
Disability (Please tick as many as applicable)

Thank you for completing this form