DOCUMENT 2 (COVERSHEET)

Application for promotion from 1st October 2018 to the office of: - (please tick one)
Professorship  □   Readership  □   University Senior Lectureship  □

Personal Statement by the Applicant
Please see Section 7 (Document 2)

Applicant: _______________________ Faculty/Department: _____________________
The statement attached to this form should not exceed 1,000 words including annotations (a word count should be provided at the end of the statement), should cover the officer’s full range of duties, and be presented in the light of the criteria for promotion, which are set out in Section 5.  The statement should provide information regarding achievements since the last promotion, if applicable.
□ Reapplication  									
Please tick the box if this is a reapplication for promotion for the office specified above and you previously applied in the 2017 (last year’s) exercise. Note that no more than 2 applications should be made in any 3-year period. 

□ Interdisciplinarity									
If you believe your application to be interdisciplinary (see Section 6), tick the box and ensure that your personal statement explains the interdisciplinary nature of your work and indicates those institutions which your work mostly concerns.                           

□ Additional considerations 							
If you believe that personal circumstances should be taken into consideration when evaluating your teaching, research or general contribution, please refer to 6.7, 7.34 and Appendix I, 3.2 – 3.4, tick the box and ensure that you provide details, including the impact these have had on your ability to carry out your usual duties, in the attached annex to Document 2.
						
□ Teaching (tick box if not applicable; see 7.12 for further information)							
With regard to those whose duties include teaching, the statement should include a self-assessment of the impact of the applicant’s Faculty/Departmental and College teaching (if applicable) on students.  Student feedback is an important factor in assessing the effectiveness of teaching.  At present individual Faculties/Departments employ their own methods for assessing such effectiveness.  In order to provide as fair an opportunity as possible for each applicant to demonstrate his or her effectiveness, applicants are requested to provide a self-assessment which takes into account student feedback on the courses they teach and have taught.  This self-assessment will be commented on by the Head of the institution (see Document 4 below).  

If College teaching is applicable (see Section 7, Document 4) (the statement required on Document 5 should be sought from: 

Name of Senior Tutor: _______________________ College: _______________________

□ NHS Consultant contract
If you hold an NHS Consultant contract please tick the box and indicate this in your statement as Document 6 will need to be sought from the appropriate NHS hospital.

□ Veterinary Clinical Work
If you are engaged in veterinary clinical work and postgraduate veterinary teaching and training, please tick the box and indicate this in your statement as a report on the clinical aspects of your work will be sought using Document 6V.

Declaration

I attach a completed application for promotion.  I confirm that before preparing my application I sought advice from my Head of Institution or an appropriate senior academic colleague about the requirements of this scheme and the timing of an application, in accordance with para 1.5 of the guidance.

All outcome letters will be sent by internal post to the applicant’s departmental/faculty address.  If you would also like to receive your outcome letter by email, please complete your details below:
□ I would like to receive my outcome letter by personal email.  The email address to be used is as follows ………………………..

After completing this form, please sign and date it:

Signed: _____________________________Date:_______________________

DOCUMENT 2 (ANNEX)

ADDITIONAL CONSIDERATIONS
The statement should not exceed 500 words (please use a separate sheet if necessary)

Please provide details of any and all personal circumstances that you wish to  be taken into consideration when evaluating your teaching, research or general contribution (for example, caring responsibilities, periods of maternity/paternity/adoption leave, bereavement, ill health or injury, or disability),  giving details of this impact on your duties.  

Any individual declaring a health or disability issue may wish to provide a current occupational health assessment where appropriate.

The information you provide will be taken into account by the promotions committees when assessing your case.  (This Annex will not form part of the applicant documentation sent to referees.)

If you have concerns about disclosing details of your personal circumstances because of its sensitive nature, please contact your HR Business Manager for advice on how to proceed.

Signed: _____________________________Date:_______________________