Application Form. Personal Details. When completed submit electronically to: Title: First Name: Surname: Address: Address:

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1 Application Form When completed submit electronically to: Personal Details Title: First Name: Surname: Address: Address: Alternative address: Home telephone number: Mobile telephone number: National insurance number: Are you a current Civil Servant? Yes No What is your preferred language for assessment? English Welsh

2 Nationality Before you complete this application form you need to be aware that as the Welsh Revenue Authority is a Non-Ministerial Government Department, people have to meet certain legal requirements to work here. Applications will only be considered from United Kingdom or Republic of Ireland Nationals, British Nationals (overseas), British Protected Persons, Commonwealth Citizens, EEA Nationals of other member states and certain non EEA family members and Swiss nationals under the EU Swiss agreement, or in some circumstances, Turkish nationals. Further information on whether you are able to apply is available here ( Confirmation of your nationality and immigration status is mandatory. If successful we will seek verification of the details you provide here in the Nationality and Immigration Status Form. Do you meet the Civil Service nationality requirements? Yes No Please provide your present nationality: Are you a legal resident in the United Kingdom? Yes No Are you under immigration control? Yes No If yes please give details: Are there any restrictions on you continuing to live in the UK? Yes No If yes please give details: Note: If appointed, evidence of eligibility to work in the UK will need to be provided.

3 Languages Please tell us about your level of ability in Welsh: Reading: 1 = Can read some basic words and phrases with understanding 2 = Can read simple material on everyday topics with understanding 3 = Can read some routine work-related material with support e.g. dictionary 4 = Can read most work-related material 5 = Full understanding of all work-related material Spoken: 1 = Can hold a basic conversation in Welsh 2 = Can converse in simple work-related conversations 3 = Can converse in some work-related conversations 4 = Can converse in most work-related conversations 5 = Fluent Understanding: 1 = Can understand parts of a basic conversation 2 = Can understand basic conversations about everyday topics 3 = Can understand routine work-related conversations 4 = Can understand most work-related conversations 5 = Can understand all work-related conversations

4 Written: 1 = Can write basic messages on everyday topics 2 = Can write simple work-related correspondence 3 = Can prepare routine work-related material with checking 4 = Can prepare most written work in Welsh 5 = Can prepare written material for all work-related matters Where did you first hear about this position? WRA Website Civil Service Jobs Job Centre Specialist publication Other If you have selected specialist publication or other, please specify: Disability Confident We are a Disability Confident Employer, and operate the Guaranteed Interview Scheme for disabled people. Under the Scheme, we will guarantee an interview to disabled people if they meet the minimum criteria for the post applied for. I have a disability and would like to be given a guaranteed interview under the Guaranteed Interview scheme Yes No Assistance at interview Will you require assistance if invited to attend an interview, assessment centre or to complete an online test? Yes No If Yes, please provide detail here any specific needs or equipment that you may need:

5 Equal Opportunities Monitoring Form Gender Female Male Is your gender identity the same as the gender you were born with? Yes No Prefer Not to Say Are you married or in a civil partnership? Yes No Prefer Not to Say Are you currently pregnant or have you been pregnant in the last year? Yes No Prefer Not to Say Age range Prefer not to say How would you describe your national identity? British or Mixed British English Northern Irish Scottish Welsh Other national identity Prefer not to say What is your ethnicity? White Gypsy or Irish Traveller Irish Welsh English Scottish Northern Irish British Other white background Mixed, multiple ethnic groups White and Asian White and Black Caribbean White and Black African Any other mixed background

6 Asian or Asian British Bangladeshi Chinese Indian Pakistani Any other Asian background Black African Caribbean Any other Black background Other ethnic group Arab Any other ethnic group Prefer not to say What is your sexual orientation? Bisexual Gay Man Gay woman, lesbian Heterosexual, straight Other Prefer not to say What is your religion or belief? Agnostic Atheist Baha l Buddhist Christian Hindu Humanism Jainism Jewish Muslim Paganism Rastafarian Shinto Sikh Tao Zoroastrian Other religion No religion Prefer not to say Disability The Equality Act 2010 defines disability as: A physical or mental impairment which has a substantial and long term adverse effect on a person s ability to carry out normal day-to-day activities. Do you consider yourself to be disabled as defined by the above Equality Act 2010? Yes No This information is collected for monitoring purposes only and is not seen by the selection panel

7 Declaration I declare that all the information I have given on this application is true to the best of my knowledge and belief. Name: Date: Mae r ddogfen yma hefyd ar gael yn Gymraeg. This document is also available in Welsh. Crown copyright 2018 WG35211