Position applied for

Salary expected

Where did you hear about this vacancy?

When would you be available to start?

If offered this position will you continue to work in any other capacity?

YesNo

Have you previously worked for us?

YesNo

Surname

Forenames

Title (Mr, Mrs, etc)

Current address (incl. postcode)

Daytime telephone number

Home telephone number

Mobile telephone number

Email

Date of Birth

Marital Status

National Insurance Number

Do you have the right to take up employment in the UK and, if necessary, a Work Permit?

YesNo

To comply with the Asylum & Immigration Act 1996, if you are invited to attend an interview, you must bring with you evidence of your eligibility to work in the UK, preferably a document which includes your National Insurance Number, such as P45. P46, P60 or a pay slip. No offer of employment will be made unless such evidence has been produced.

Beginning with the most recent, give details of your education, qualifications and training to date. Include under “Details” the places you attended.

Do you have any other training, qualifications or skills relevant to the position?

Please give details of your last four jobs, beginning with your present or most recent. Any relevant positions held before then may also be mentioned.

Do you have any other training, qualifications or skills relevant to the position?

Driving Licence Number

Driving Licence Type

FullProvisional

Do you have any current endorsements. If yes, please give details:

Note: If you are invited to attend an interview, and your driving licence is relevant to your application, please bring it with you.

Interests/Hobbies:

Please use this space to say why you are interested in the position for which you have applied and provide any other information that may assist your application.

How many weeks or months notice do you have to give to your current employer?

If you are disabled, please give details of any special arrangements you would require to attend an interview.

Have you ever been convicted of a criminal offence? (Declaration subject to the Rehabilitation of Offenders Act):

Please give details of two referees, one of whom should be your current or most recent employer. The other should not be a relative or peer.

First referee

Name

Occupation

Address

Second referee

Name

Occupation

Address

Data Protection Notice:
All information disclosed will be treated in the strictest confidence, and will be issued only for the purposes detailed in the Data Protection Act 1998

Certain information is requested prior to you commencing employment with our company, in order to ensure you are able to carry out the requirements of the job, ensure you personal safety and to meet our statutory obligations imposed by the relevant Health and Safety regulations. The information is also required to establish if we may need to make any reasonable adjustments to assist you in performing the work, in accordance with the requirements of the Disability Discrimination Act 1995.

Your Doctor will not be contacted without prior written consent to do so.

Medical History: Have you ever suffered from any of the following ailments in the past?

Circulatory problems such as varicose veins, phlebitis or thrombosis.

YesNo

Heart problems, angina, hypertension or heart attack or stroke

YesNo

High blood pressure

YesNo

Respiratory Problems such as asthma, frequent cough or severe bronchitis

YesNo

Allergies

YesNo

Diabetes

YesNo

Epilepsy or fainting attacks

YesNo

Frequent headaches

YesNo

Skin disorders

YesNo

Recent operations or bone fractures

YesNo

Back trouble, arthritis or rheumatism

YesNo

Injuries to bones, joints, tendons, including wrist tendons

YesNo

Please give details where appropriate?

Are you currently on any medication?

YesNo

If yes please give details

Have you suffered from any other significant health problems including eyes, hearing, skin etc?

YesNo

If yes please give details

Have you ever made a claim for industrial Disease or Injury?

YesNo

If yes please give details

Have you ever been absent from work due to stress/stress related illness?

YesNo

If yes please give details

Have you worked in an industry with high noise levels or been exposed to the use of hand held vibratory tools?

YesNo

If yes please give details

Have you ever worked in a dusty environment?

YesNo

If yes please give details

Name

Address

Telephone Numbers

Relationship

Doctors name

Address

Telephone Numbers

Data Protection Act 1998

The Company needs to collect and use certain types of information about employees, in order to operate its business and to fulfil its legal obligations under the Data Protection Act 1998. The Company will take all reasonable precautions at all times to guard information against any unauthorised access and use.

To the best of my knowledge and belief the information I have given on the form is correct. I consent to the Company holding this information on file, for as long as it considers necessary, to fulfil the purpose for which it was obtained and to process it in accordance with the requirements of the Act or other procedures implemented by the Company for this purpose from time to time.

It is the Company’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, national origin, sex or marital status or disability.

Declaration

I declare that the information I have given on this form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified or, if I have already been appointed, I may be dismissed. I hereby give my consent to the Company processing the data supplied on this application form for the purpose of recruitment and selection, and for it to be held on file under the terms of the Data Protection Act 1998.

I authorise the Company to obtain references to support this application, and release the Company and referees from any liability caused by giving and receiving information.