APPLICATION FOR
MINI PUPILLAGE

SECTION A - PERSONAL INFORMATION COVER SHEET

Full Name:

Correspondence Address 
including postcode:

If this is a term-time address, please include a home address as well, together with dates for the periods that you will be at each address.

Home/Web Email Address:

Phone Numbers	Home:

Work:

Mobile:

Date of Birth:	
(Needed to ensure you are at least 18)

PLEASE DO NOT SEND A CV OR PHOTOGRAPHS.
PLEASE DO NOT PROVIDE DETAILS OF YOUR HOBBIES OR OF REFEREES.
THIS COVER SHEET AND FOLLOWING EQUAL OPPORTUNITIES MONITORING FORM IS NOT DISCLOSED TO THE PERSON WHO DETERMINES THE APPLICATIONS FOR MINI PUPILLAGES.
CONFIDENTIAL EQUAL OPPORTUNITIES MONITORING FORM

The contents of this document are strictly confidential.

The purpose of the form is to allow us to monitor the effectiveness of our Equal Opportunities Policy by way of an annual review. 

We do not currently ask questions relating to sexual orientation, religious belief, marital or civil partnership status or gender reassignment status as these are essentially private matters. We do ask questions relating to sex, age, disability and ethnic origin as these are potentially visible factors. 

I consent for the personal date provided on this form to be used solely for the purpose of an annual review of the effectiveness of the Equal Opportunities Policy.

Signed ___________________________		      Dated___________
 
Sex		Female			  Male                     Prefer not to say

Age last birthday

16-24	          25-34          35-44	        45-54	       55-64         65+       Prefer not to say

Disability
The Equality Act 2010 generally defines a disabled person as someone who has a mental of physical impairment that has a substantial and long-term adverse effect on the person’s ability to carry out normal day-to-day activities.

Do you consider yourself to have a disability according to the definition in the Equality Act? 

         Yes                      	 No                     Prefer not to say
	
Ethnic Group

A	White
	 British / English / Welsh / Northern Irish / Scottish
	 Irish
	 Gypsy or Irish Traveller
	 Any other White background, Please write in ____________________

B	Mixed / Multiple Ethnic Groups
	 White and Black Caribbean
	 White and Black African
	 White and Asian
	 White and Chinese
	 Any other Mixed / Multiple Ethnic background Please write in _______________

C	Asian / Asian British
	 Indian
	 Pakistani
	 Bangladeshi
	 Chinese
	 Any other Asian background Please write in ____________________

D 	Black / African / Caribbean / Black British
	 Caribbean
	 African
	 Any other Black / Caribbean / Black British Please write in _____________

E	Other Ethnic Group
	 Arab
	 Roma
	 Any other Ethnic Group Please write in _____________

F     	  Prefer not to say

Socio-economic background

Did you mainly attend a state or fee paying school between the ages of 11-18?

 UK non-selective state school (e.g. comprehensive school)
 UK selective state school (e.g. grammar school)
 UK fee-paying school (private / independent school)
 UK fee-paying school (supported by a means tested scholarship)
 Attended school outside the UK
 Prefer not to say

Thank you for completing this questionnaire within the application form.

EDUCATIONAL QUALIFICATIONS ACHIEVED

Institution	               Qualification		      Subject	                Grade

				

				

				

				

				

				

				

				

				

				

We do not want to know the dates on which you obtained the qualifications. 
Please specify subjects or modules for degree courses.

EDUCATIONAL QUALIFICATIONS CURRENTLY BEING UNDERTAKEN

 Institution  		     Qualification 	       Subject 		   Estimated date of 
                                                                                                                    completion

				

				

				

				

Please specify subjects or modules for degree courses.

OTHER TRAINING COURSES

	

EXPERIENCE - PAID EMPLOYMENT/SELF EMPLOYMENT 
Starting with the most recent and then going in reverse chronological order.

Duration	   Employer 			Job Title/Role/Duties/Skills

			

			

			

			

EXPERIENCE – VOLUNTARY WORK/PRO BONO/PUBLIC SERVICE / WORK EXPERIENCE.

Duration 	  Organisation		Role/Duties/Skills

			

			

			

			

PLEASE PROVIDE A BRIEF EXPLANATION AS TO WHY YOU WOULD LIKE A MINI PUPILLAGE AT 29 BEDFORD ROW.

	

PLEASE TICK THIS BOX TO CONFIRM THAT YOU HAVE READ THE INFORMATION REGARDING MINI PUPILLAGES SET OUT ON OUR WEBSITE AND ACCEPT THE BASIS UPON WHICH ANY MINI PUPILLAGE IS CARRIED OUT AT 29 BEDFORD ROW.

Thank you for completing the application form.
Please post to:
Nicola Kessell
Chambers Administrator
29 Bedford Row
London.  WC1R 4HE.