APPLICATION FORM The information you supply on this form will be treated in confidence. Post Applied for: Section 1: Personal Details Title First Name Last Name Address Postcode Mobile Telephone Number SIA Badge Number Are you eligible to work in the UK?—Please choose an option—YesNo Your National Insurance Number Your email address Do you hold a full UK Driving Licence? —Please choose an option—YesNo Do you have any points or convictions etc? —Please choose an option—YesNo Please state current Salary Package including benefits & holidays: You are required to provide evidence of the above details at your interview by bringing with you: * Proof of eligibility to work in the UK (Passport I Birth Certificate etc) * Driving Licence & Counterpart * Your last 3 months wage slips * Last years P60 (Sales roles only) * Proof of current holiday entitlement * Proof of Credit Card or ability to obtain one (Sales roles only) Section 2: Rehabilitation of Offenders Act Have you ever been convicted of a criminal offence? —Please choose an option—YesNo Have you any prosecution pending? —Please choose an option—YesNo If yes, please give details /dates of offence(s) and sentence: Section 3: Health Number of days absent in the last 2 years? Please state number of times in the last 2 years? Are you registered disabled? —Please choose an option—YesNo If yes, please provide your disability number and details: Section 4: Education Date To: Date From: Name of the School Examinations taken and Qualifications Date To: Date From: Name of the School Examinations taken and Qualifications Date To: Date From: Name of the School Examinations taken and Qualifications Date To: Date From: Name of the School Examinations taken and Qualifications Section 5: Employment Record Please list chronologically, starting with current or last employer Date From: Body: Job Title/ Job Function/ Responsibilities: Salary and Reason for Leaving Date From: Body: Job Title/ Job Function/ Responsibilities: Salary and Reason for Leaving Date From: Body: Job Title/ Job Function/ Responsibilities: Salary and Reason for Leaving Date From: Body: Job Title/ Job Function/ Responsibilities: Salary and Reason for Leaving Section 6: Personal Attributes In this section to add any further information which directly relates to your suitability for this position. Section 7: References Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are. (NB. References will only be taken if you commence employment with us) Name: Their Position (Job title): Work Relationship: Organisation: Dates Employed: Address: Postcode: Telephone: E-mail: Name: Their Position (Job title): Work Relationship: Organisation: Dates Employed: Address: Postcode: Telephone: E-mail: Section 8: Declaration I confirm that the information provided in this application and within my Curriculum Vitae is both truthful and accurate. I have omitted no facts that could affect my employment. understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file. Signed: Date: Section 9: Recruitment Monitoring Form This is separated form your application from upon receipt and does not form part of the selection process. It will be retained by the Human Resources purely for monitoring purposes. Application for the post of: What is your Ethnic Group? —Please choose an option—WhiteWhite UK IrishWhite non-UKMixedWhite & Black CaribbeanWhite & Black AfricanWhite & AsianIndianPakistanBangladeshiBlack CaribbeanBlack AfricanChineseVietnameseI do not wish to provide this information Gender —Please choose an option—MaleFemale Disability Do you consider your self disabled? —Please choose an option—YesNo Age —Please choose an option—16-2516-2526-3536-5546-5556-6566-70Over 70
