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12th May 2010 Dear Applicant Thank you for your interest in ...

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Professional Qualification<br />

Qualification Exam Date Result<br />

Employment History (Please start with <strong>you</strong>r present or last employment)<br />

Number of<br />

years/months<br />

employed<br />

Name & Address of<br />

Employer<br />

Position Held & Brief Outl<strong>in</strong>e<br />

of Duties<br />

Reason <strong>for</strong> Leav<strong>in</strong>g Salary<br />

Medical History/Disability<br />

In l<strong>in</strong>e with the Disability Discrim<strong>in</strong>ation Act 1995, a disability is def<strong>in</strong>ed as ‘a physical or mental<br />

impairment which has a substantial and long-term adverse effect on <strong>you</strong>r ability to carry out normal day<br />

to day activities. Please detail if <strong>you</strong> consider <strong>you</strong>rself as hav<strong>in</strong>g a disability.

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