Application Form

 

Application forms and all other documents relating to all applications 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*
Email Address*
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?*
Do you have a valid passport?*
Do you have a full driving license?*
Endorsements*
If YES, please give dates
Have you any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974)?*
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?*
If YES, please give full details
Are you subject to any restrictions or covenants which might restrict your working activities?*
If YES, please give full details
Are you willing to work overtime and weekends if required?*
Please give details of any hours you would not wish to work
Do you smoke?*
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?*
Have you ever worked for this business before?*
If YES, please give full details
Are you related to or do you know any person employed by the business?*
If YES, please give full details
Have you ever applied for employment with this business before?*
Do you need a work permit to take up employment in the UK?*
How much notice are you required to give to your current employer?*
Do you have your own transport*
 
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*
Asthma*
Hay Fever*
 
Cardiovascular
Chest Pain*
Heart Disorder*
High Blood Pressure*
Palpitations*
Rheumatic Fever*
 
Digestive System
Hernia*
Jaundice*
Peptic Ulcer*
Rectal Bleeding*
 
Neurological
Dizzy Spells*
Epilepsy*
Fainting Attacks*
Paralysis*
Severe Headaches*
 
Genito-Urinary
Kidney Stones*
Pain on Urination*
Sugar/Albumin Urine*
 
Respiratory
Chronic Cough*
Pleurisy*
Pneumonia*
Sinusitis*
Tuberculosis*
 
Musculoskeletal
Arthritis*
Backache*
Back Injury*
Disc Disorder*
Gout*
Joint/Tendon Disorder*
Rheumatism*
 
Senses
Colour Blindness*
Ear Disorder*
Eye Disorder*
Nose Disorder*
Throat Disorder*
Speech Disorder*
Dyslexia*
 
Miscellaneous
Anaemia*
Anxiety*
Blood Disorder*
Cancer*
Depression*
Diabetes*
General Debility*
Insomnia*
Skin Disorder*
Dermatitis*
If YES, please give full details