APPLICATION FORM

All information given on this form will be treated as confidential, but if a position is offered, previous employers will be approached for a reference.

ALL QUESTIONS MUST BE ANSWERED

 

SECTION 1 : PERSONAL DETAILS

Mr/Mrs/Miss

 

Forenames

Surname

Home Address

 

 

 

Telephone Number

Postcode

 

Date of Birth

Nationality

 

Registered Disabled

YES/NO

Registered Disabled Number (if applicable)

 

For Health and Safety purposes, please state any medical conditions/learning or language difficulties that may have an impact on your normal working activities. (This information will be used to assess any individual needs you may have in the workplace)

 

Give details of operations and major illnesses during the last 3 years

 

 

Give details of number of days absent through sickness in the last 12 months

 

Do you hold a current Driving Licence?

 

Give details of any Driving Licence endorsements

 

Give details of any legal proceedings taken against you, that are not spent under the Rehabilitation Act

 

If you are related to anyone in the company, please give details

 

 

SECTION 2 : SECONDAY AND FURTHER EDUCATION

School/College/University

From

To

Qualifications Gained

 

 

 

 

      

 

SECTION 3 : CAREER HISTORY

Employers Name and Address

 

 

 

Dates

Responsibilities

 

 

 

 

 

 

 

Reasons for Leaving

 

 

 

 

Employers Name and Address

 

 

 

Dates

Responsibilities

 

 

 

 

 

 

 

Reasons for Leaving

 

 

 

 

Employers Name and Address

 

 

 

Dates

Responsibilities

 

 

 

 

 

 

 

Reasons for Leaving

 

 

 

 

SECTION 4 : HOBBIES AND INTERESTS

 

 

 

 

 

 

SECTION 5 : ANY OTHER RELEVANT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 6 : REFERENCES

All appointments are subject to the receipt of satisfactory references. Please provide details of two referees to who confidential enquiries may be made.(One of them must be a previous employer)

Name

 

 

Position

 

 

Address

 

 

 

Telephone

 

 

Relationship

 

 

Name

 

 

Position

 

 

Address

 

 

 

Telephone

 

 

Relationship

 

 

 

I accept that my employement is subject to my completing the application form accurately to the best of my knowledge and belief, and subject to satisfactory references being provided

Signed

______________________________________________________________

 

Date

 

 

_____________________