Pearl Window Systems

Application Form

 

Application forms and all other documents relating to all applicants will be kept for a minimum of 6 months.

 

Please complete the below form.

 
 
 
Position Applied For*
 
 

Personal

 
 
Address
First Name(s)*
Surname(s)*
Address*
City
Postcode*
Home Telephone Number*
Mobile Telephone Number
National Insurance Number
 
 
Next Of Kin
First Name(s)
Surname(s)
Address
City
Postcode
Home Telephone Number
Mobile Telephone Number
Relationship
 
 
Do you have a bank account?*Yes No
Do you have a valid passport?*Yes No
Do you have a full driving license?*Yes No
Endorsements:*Yes No
If YES, please give dates:

Have you any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974)??*
Yes No
If YES, please give full details:

Are you involved in any activity which might limit your availability to work or your working hours e.g. local government?*
Yes No
If YES, please give full details:

Are you subject to any restrictions or covenants which might restrict your working activities?*
Yes No
If YES, please give full details:

Are you willing to work overtime and weekends if required?*
Yes No
Please give details of any hours you would not wish to work:

Do you smoke?*
Yes No
You may be required as part of your Application to complete the attached Pre-Employment Medical Questionnaire. Are you prepared to undergo a medical examination prior to employment?*
Yes No
Have you ever worked for this business before?*
Yes No
If YES, please give full details:

Are you related to or do you know any person employed by the business?*
Yes No
If YES, please give full details:

Have you ever applied for employment with this business before?*
Yes No
Do you need a work permit to take up employment in the UK?*
Yes No
How much notice are you required to give to your current employer?*
Do you have your own transport?*
Yes No
 
 

Qualifications

Please list your qualifications:

 
 

Experience

Please list your relevant experience:

 
 

References

By completing this section you consent to the Company taking up references.

Reference 1
Name and Address of Contact at previous employer:

Reference 2
Name and Address of Contact at previous employer:

 
 

Pre-Employment Medical Questionnaire

Please answer the following questions. If the answer is YES then please provide full details.
 
Name of Doctor
Address
City
Postcode
 

Allergies

Allergies*Yes No
Asthma*Yes No
Hay Fever*Yes No
 

Cardiovascular

Chest Pain*Yes No
Heart Disorder*Yes No
High Blood Pressure*Yes No
Palpitations*Yes No
Rheumatic Fever*Yes No
 

Digestive System

Hernia*Yes No
Jaundice*Yes No
Peptic Ulcer*Yes No
Rectal Bleeding*Yes No
 

Neurological

Dizzy Spells*Yes No
Epilepsy*Yes No
Fainting Attacks*Yes No
Paralysis*Yes No
Severe Headaches*Yes No
 

Genito-Urinary

Kidney Stones*Yes No
Pain on Urination*Yes No
Sugar/ Albumin Urine*Yes No
 

Respiratory

Chronic Cough*Yes No
Pleurisy*Yes No
Pneumonia*Yes No
Sinusitis*Yes No
Tuberculosis*Yes No
 

Musculoskeletal

Arthritis*Yes No
Backache*Yes No
Back Injury*Yes No
Disc Disorder*Yes No
Gout*Yes No
Joint/ Tendon Disorder*Yes No
Rheumatism*Yes No
 

Senses

Colour Blindness*Yes No
Ear Disorder*Yes No
Eye Disorder*Yes No
Nose Disorder*Yes No
Throat Disorder*Yes No
Speech Disorder*Yes No
Dyslexia*Yes No
 

Miscellaneous

Anaemia*Yes No
Anxiety*Yes No
Blood Disorder*Yes No
Cancer*Yes No
Depression*Yes No
Diabetes*Yes No
General Debility*Yes No
Insomnia*Yes No
Skin Disorder*Yes No
Dermatitis*Yes No
 
If YES, please give full details:

 
 
I understand that misrepresentation, falsification or omission of information requested on this application form may be a reason for dismissal.
 
 
* required fields
 
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