Post applied for:
Name:
Address:
"POST" Code:
Tel:
email:
National Insurance Number:
Sex: Date of Birth:
Do you smoke: Do you have a driving licence:
If Commercial, give class of vehicle: Is your driving licence “clean”:
If “No”, please give details:
Do you have criminal convictions that have °Ccurred during the past 5 years?
If “ Yes” give details:
(Note: You do not have to disclose any offence which is a spent offence under the Rehabilitation of Offenders Act 1974)
Have you at any time been convicted of a crime that has resulted in a prison sentence? If “Yes” give details:
(Note: You do not have to disclose any offence which is a spent offence under the Rehabilitation of Offenders Act 1974)
Are you legally eligible to live and work in the UK in accordance with the Asylum and Immigration Act 1996?: Can you provide a specified d°Cument such as a passport, P60 or UK birth certificate to confirm your answer: If you are not a UK or EU National, please give your work permit number:
Are you in generally good health?: If “No” give details:
Are you receiving medical treatment?: If “Yes” give details:
Have you in the past 10 years had a period of illness resulting in a long term (more than 4 weeks) absence from work?: If “Yes” give details:
Are you registered disabled or do you otherwise suffer from any disability?: If “Yes” give details:
Do you require special arrangements as to access to premises, special seating or other equipment or of any other nature because of your disability? If “Yes” give details:
Are you willing to undergo a medical examination: Marital status: Do you have children? If “Yes” please give number of children and their ages
Are you bankrupt or have you ever been declared bankrupt: If “Yes” give details:
Do you have outside commitments that could limit your working hours, such as being a JP, a councillor in l°Cal government or a member of the TA?: If “Yes” give details:
Ethnic origin (Voluntary information). We are an equal opportunities employer. We aim to recruit staff on their suitability for the position advertised, without consideration of age, sex, marital status, disability or ethnic origin. To help us monitor this policy it will help us if you fill in this section.
Availability for work If currently employed, how much notice will you have to give you current employer?:
Is there any other reason why you would not be able to start work immediately if you were offered the job you have applied for?: If “Yes” give details:
Do you have any existing holiday commitments?: If “Yes” give details:
Are you willing to travel during the course of your employment?: If “No” give details:
Education, Skills and Qualifications Please give details of any skills and qualifications and/or experience relevant to the job for which you have applied: Education: Please list schools, colleges, universities attended (from age 14):
Employment History Are you currently employed: If “No” please state why not:
Have you ever been dismissed by an employer?: If “Yes” give details, including the reasons given for your dismissal:
Your current or last employer:
Name of company:
Address:
Telephone number:
Describe your main duties and responsibilities:
Rate of pay:
Reason for leaving or wanting to leave: Previous employer (1):
Name of company:
Address:
Telephone number:
Describe your main duties and responsibilities:
Rate of pay:
Reason for leaving or wanting to leave:
Previous employer (2):
Name of company:
Address:
Telephone number:
Describe your main duties and responsibilities:
Rate of pay:
Reason for leaving or wanting to leave:
Previous employer (3):
Name of company:
Address:
Telephone number:
Describe your main duties and responsibilities:
Rate of pay:
Reason for leaving or wanting to leave:
Previous employer(4):
Name of company:
Address:
Telephone number:
Describe your main duties and responsibilities:
Rate of pay:
Reason for leaving or wanting to leave:
Other information relevant to your employment history:
Do you have any part time or evening jobs which you intend to continue:
If “Yes” give details:
References: Please give details of two people we can contact who are willing to give you a reference and who are not related to you:
Ref (1):
Ref (2):
Interests and hobbies Please give brief details of your main interests and hobbies:
The job you have applied for Please state what attracted you to the job you have applied for and why you think you are a suitable person to do it: Declaration
I declare that the information I have given on this form is correct and that any misrepresentation by me may be sufficient grounds for my dismissal if I am employed. I give my permission for my previous employer(s) and any references given to be contacted.
Please check this box to affirm the above declaration:
Date:
Consent under the Data Protection Act 1998 - the information given to [employer] in this form will be pr°Cessed only by [employer] for the purpose of considering your application for employment. If you are successful in your application this form and the information in it will be retained in your HR file for such time as you are an employee of [employer] and for up to 6 years after the end of your employment.
Otherwise this form will only be retained by [employer] for so long as it is required in connection with your application.
By signing this consent you give us your express consent to retain and pr°Cess all the information contained in this form and to transfer it to countries outside the European Economic area if required.
Attach your CV.
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