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JOB APPLICATIONS
 
Position Applied For:

The following information will be treated in the strictest confidence.

PERSONAL
Surname
First Name(s)
Address
Post Code
Contact Telephone Date of Birth (dd/mm/yyyy)
Your E-mail
 
Full Driving Licence Yes  No  Endorsements Yes  No 
If endorsements please give details including dates
Are you involved in any activity which might limit your availability to work or your working hours e.g. local government? Yes  No 
If YES, please give details
Are you willing to work overtime and weekends if required? Yes    No   
Please give details of any hours which you would not wish to work
Have you any convictions (other than spent convictions under the Rehabilitation of offenders Act 1974)? Yes  No 
If YES, please give full details
You may be required, if offered employment, as part of your Application to complete a Pre-Employment Medical Questionnaire. Are you prepared to undergo a medical examination prior to employment? Yes  No 
Have you ever worked for this Company before? Yes  No 
If YES, please give full details
Have you applied for employment with this Company before? Yes  No 
Do you need a work permit to take up employment in the UK? Yes  No 
How much notice are you required to give to your current employer?
EDUCATION
Schools attended since age 11 From To

Examinations and Results
College or University From To Courses and Results
Further Formal Training From To Diploma/Qualification
Job related Training Courses
Name of Organisation		 Date Subject
Please give details of membership of any technical or professional associations:
Please list any foreign languages spoken and the level of competence:
EMPLOYMENT DETAILS
Please give details of your past employment, excluding your present or last employer, stating the most recent first
Name & address of employer Dates Position held/Main duties Reason for leaving
PRESENT OR LAST EMPLOYER
Are you currently employed? Yes  No 
Name of present or last employer
Address
Telephone No.
Nature of business
Job title and a brief description of your duties
Length of Service From To
INTERESTS, ACHIEVEMENTS, LEISURE ACTIVITIES  (e.g. hobbies, sports, club memberships)
SUPPLEMENTARY INFORMATION
Please set out below any further information to support your application, e.g. past achievements, future aspirations, personal strengths.
REFERENCES
Please give the names of two people (one of which should be your present or most recent employer) whom we may approach for a reference.
Can we approach your current employer before an offer of employment is made Yes  No 
Name Name
Position Position
Address Address
Tel No. Tel No.
SOURCE OF APPLICATION
How did you hear of this vacancy?
PRE-EMPLOYMENT MEDICAL QUESTIONNAIRE
Should we consider it necessary to contact your doctor, do we have your permission? Yes  No 
Your doctor's name and address
1. How many days' absence have you had from work in the last three years? Days 
2. Are you currently on medication (excluding contraception)? Yes  No 
  If YES, please give further details 
3. Have you spent time in hospital in the last three years? Yes  No 
  If so, why? 
4. Do you suffer from any injury, illness, medical condition or allergy that might affect your ability to perform your duties? Yes  No 
  If YES, please give further details 
5. Do you consider yourself to have a disability? Yes  No 
  If YES, please give further details 
Data Protection Notice:

The Company requires certain information before you start employment, to ensure you will be able to perform the requirements of the job and give reliable service, and to ensure compliance with relevant Health and Safety regulations. The information is also required in order to establish whether any reasonable adjustments may need to be made to assist you in performing your duties, in accordance with the Disability Discrimination Act 1995.

The information you provide will be treated in the strictest confidence, and used only for the purposes detailed above in compliance with the Data Protection Act 1998.
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In submitting this form I declare that the information given is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal.

I understand these details will be held in confidence by the Company, for the purposes of assessing this application, ongoing personnel administration and payroll administration (where applicable) in compliance with the Data Protection Act 1998.

I place a tick in this box to signify my agreement to the above statements.