Job Application Form

Job Application

Please complete the form below to apply for a position with us.
Applying for Position*
Full Name*

First NameMiddle NameLast Name
Current Address*

Address

Address Line 2

TownCounty

Post Code
NI Number*
NI Number
Any restrictions on your taking up employment in the UK? If yes please provide details.*
Clean Driving Licence*

YesNo
Driving Groups
Details of Motoring Endorsements:
Details of Motoring Claims in Last 5 years:
Email Address*
Home Phone Number*

Area CodePhone Number
Mobile Phone Number*

Area CodePhone Number
Schools Attended / Dates*
Quailfications*
Colleges & Universities Attended / Dates
Qualifications
Other Qualifications and Training
EMPLOYMENT HISTORY:

Please complete all details
Employment*

Name / Address of Employer

Title / Duties

To - From DateSalary

Reason for Leaving
Employment*

Name / Address of Employer

Title / Duties

To - From DateSalary

Reason for Leaving
Employment

Name / Address of Employer

Title / Duties

To - From DateSalary

Reason for Leaving
Employment

Name / Address of Employer

Title / Duties

To - From DateSalary

Reason for Leaving
Employment

Name / Address of Employer

Title / Duties

To - From DateSalary

Reason for Leaving
Employment

Name / Address of Employer

Title / Duties

To - From DateSalary

Reason for Leaving
Any further employment history
OTHER CURRENT EMPLOYMENT

Please note any other employment you would continue with if you were to be successfull in obtaining this position.
How much notice do you need to give in your current post?*
REFERENCES :

Please note here the names and addresses of two persons from whom the company may obtain both character and work experience:
Reference One:*
Reference Two:*
LEISURE :
Please note here your leisure interests, sports and hobbies, other pastimes etc.
Leisure Details:
CRIMINAL RECORD :
Please note any criminal convictions except those “spent” under the rehabilitation of Offenders Act 1974. If
none. Please state.
In certain circumstances employment is dependent upon obtaining a satisfactory basic disclosure from the
Criminal Records Bureau / Scottish Criminal Records Office.
Conviction Details:*
GENERAL COMMENTS :
Please detail here your specific reasons for this application, your main achievements to date and the strengths
you would bring to this post
Your comments:
Please specify any special arrangements you will need to attend an interview
DECLARATION

( please read this carefully before signing this application )

1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
2. I agree that the organisation reserves the right to require me to undergo a medical examination. ( Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and your permission prior to contacting your Doctor). I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data protection act..
3. I agree that should I be successful in this application, I will, if required, apply to the Criminal Records Bureau / Scottish Criminal Records Office for basic disclosure. I understand that should I fail to do so , or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated
I have read and agree the above declaration*

I agreeDon't agree
Todays Date*

DayMonthYear
Date
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