VGN - Application Form - Seasonal Workers Only

APPLICATION FORM
Personnel Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Phone Number*

Area CodePhone Number
Email*
example@example.com
Nationality*
When are you available to start work?*

MonthDayYear
Date
National Insurance Number
Right to Work
Do you have the Right to Work in the UK?*

YesNo
Share Code
Do you consent for a Right to Work check to be carried out?*

YesNo
Other
Do you have any of the following?

Valid First Aid TrainingValid Fire Warden TrainingForklift Licence - Please attach fileHGV Licence - Please attach file
Pre Booked Holiday Dates
Do you have any experience within the fresh produce industry?
Present or Most Recent Employment
Job Title
Description of Duties
Education, Training and Qualifications
Medical Questionnaire

The tasks we carry out on site have been thoroughly assessed and the following questions are a result of the findings within our risk assessments. Areas of the company are temperature controlled; we restrict where possible the number of people working in these areas. We operate a strong hygiene program on site, and it is imperative that you declare when they have any period of sickness. It is not possible to predict who may be affected, so everyone must consider himself or herself at risk and take precautions. We operate the appropriate Person Protective Equipment (PPE) and controlled working in these areas. This could take the form of coveralls, hairnet, gloves which will be provided for you, but you are fully expected to comply when shown how to wear/use this type of equipment.
Do you suffer from or have you ever suffered from any allergies to plants or insects/bees?*

YesNo
Are you colour blind?*

YesNo
Do you suffer from or have you ever suffered from any respiratory problems?

HayfeverAsthmaBronchitisChest InfectionsOther
Have you ever suffered from seizures?*

YesNo
Do you suffer from any skin diseases?

DermatitisEczemaProriasis
We limit how much individuals should lift/move and that bulk handling is done with pallet trucks and FLTs but the work we carry out on site is of a manual nature with long periods of standing, twisting, and lifting.
Do you have any pre-existing problems with your neck, back, shoulders, arms, wrists or feet?*

YesNo
The areas, which you would be required to work in, are exposed to hot temperatures
Are you able to work in these conditions safely?*

YesNo
Do you have any circulatory conditions such as:

AnginaRaynaud's DiseaseOther heart conditions
Are you currently taking any prescribed medication?*

YesNo
Do you suffer from:

DiabetesThyroid ProblemsArthritis
Do you have any health conditions that you think may affect yours or the safety of others in the workplace?
Are you currently under the care of a doctor, consultant or another medical condition?*

YesNo
Next of Kin/Emergency Contact
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
The importance of disclosing any medical conditions prior to employment is paramount to ensure the safety of yourself and others around you. The information provided on this form will be used to; (i) Assess your medical capability to do the job for which you have been employed. (ii) To determine whether any reasonable adjustments may be required to accommodate any disability/impairment you might have. (iii) To ensure that none of the requirement of the job for which you have applied for would adversely affect any pre-existing conditions you may have.
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 any information is false or misleading, or that I have withheld relevant information, my application be disqualified, or I may be dismissed due to the nature of the risk we have identified in the workplace. I hereby give my consent to the Company processing the data supplied on the application from for the purpose of recruitment and selection. However, should the need arise I also give consent to contact my GP if the information on this form requires further explanation. This also covered the need to maintain computer and paper records of my personal data which we process and store in accordance with the Data Protection Act 1998. *
Should be Empty:

APPLICATION FORM

Personnel Details

Right to Work

Other

Present or Most Recent Employment

Medical Questionnaire

Next of Kin/Emergency Contact

Declaration