CVC Services Application Form

CVC Services Application Form

Please ensure all fields are correctly filled in.
Personal Details
Name*

First NameLast Name
Position Applied for*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you require a work permit to work in the UK?*

YesNo
Nationality*
Date of Birth*

MonthDayYear
Date
Are you a Student: Yes /No If Yes Provide details below?*
Name of College/University
Do you hold a current UK Driving License?
National Insurance Number:

Employment History

Company 1
Company Name*
Company Number*
Please enter a valid phone number.
Company Email*
example@example.com
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please state Date Started & Date Ended and Summary of responsibilities and/or achievements:*

Employment History

Company 2
Company Name 2
Company Email 2
example@example.com
Company 2
Please enter a valid phone number.
Company Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company 2 Please state Date Started & Date Ended and Summary of responsibilities and/or achievements:

References

Please state below the names and addresses of two referees (including your current or last employer) and covering at least three years of employment. These people will only be contacted if a job offer is made and verbally accepted by you. Referees should not be relatives or personalfriends. We reserve the right to contact any previous employer or education establishment mentioned on this application.
Reference 1 Name*

First NameLast Name
Reference 1 Email*
example@example.com
Reference 1 Job Title*
Reference 1 Phone Number
Please enter a valid phone number.
Reference 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Criminal Convictions/Probity Declaration

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions or cautions whichfor other purposes are “spent” under the provisions of the Act, and in the event of employment, any failure to disclose such convictions orcautions could result in dismissal or disciplinary action by the Agency. Any information given will be completely confidential and will beconsidered only in relation to applications for positions to which the Order applies.
Details of convictions:
Skip if not applicable
Do you have any criminal convictions that have not become spent under the Rehabilitation of Offenders Act 1974 and/or any offences for which you are currently awaiting a court appearance?*

YesNo
Have you ever been disqualified from the practice of a profession or required to practice under specific limitations?*

YesNo
Do you have any cautions that have not become spent under the Rehabilitation of Offenders Act 1974 and/or any offences for which? you are currently awaiting a Court appearance?*

YesNo
Has your employment or contract ever been terminated orsuspended – in the UK or abroad – on grounds relating to your fitness to practice (conduct or performance?)*

YesNo

Declaration

Data Protection Act 1998This application form has been designed to provide us with sufficient basic information to carry out a preliminary assessment of yoursuitability for the post. The information you supply in this form is confidential and will only be used by those involved in the appointment inline with the Data Protection Act 1998.
By signing below, I confirm that the information given on this form is, to the best of my knowledge, complete and correct. I understand that any
incorrect or incomplete information may lead to my application being refused, my offer of employment being withdrawn, or termination of my
employment should I have commenced work.
Signature*

Clear
Should be Empty:

Personal Details