Position applied for:	please specify :
How did you hear of this vacancy?

Last name:*
First names:*
Address:*
Postcode:*
Telephone (day):*
Telephone (evening):
Mobile:
E-mail:*

Have you previously worked here?	Yes No
Have you previously applied for work here?	Yes No
Do you have friends or relatives working here?	Yes No
Are you currently eligible for employment in the UK?	Yes No
Do you have your own transport?	Yes No
Do you have a current, clean driving licence? (Only answer this question, if the role is likely to involve travelling on behalf of the business.)	Yes No Not applicable No. of points:

If the job requires it, are you willing to:
Work shifts?	Yes No
Work nights?	Yes No
Work evenings?	Yes No
Work full-time?	Yes No
Work part-time?	Yes No
Work weekends?	Yes No
Travel?	Yes No
Relocate?	Yes No
Age if under 18

All qualified candidates are considered for available openings without discrimination because of age within statutory limits, colour, ethnic or national origin, nationality, religious belief, political affiliation, disability, gender or gender reassignment, marital status or sexual orientation. We work in a non-smoking environment.

Schools:	from	to	Examination subjects and results

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College/University:	from	to	Course and results

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Further education and formal training:	from	to	Course and results

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Professional Memberships:
Body	Date joined	Grade of membership	Date of renewal

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Please list any other courses you have attended which may be relevant to the application:

Present/last employer:
Type of business:
Address:
Postcode:
Job title/type of work
Duties:
From (dd/mm/yy)
To (dd/mm/yy)
No. of days sickness absence in last 12 months:
Present/leaving pay	per
Reason you want to leave/have left:

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Previous employer:
Type of business:
Address:
Postcode:
Job title/type of work
Duties:
From (dd/mm/yy)
To (dd/mm/yy)
No. of days sickness absence in last 12 months:
Present/leaving pay	per
Reason you want to leave/have left:

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Previous employer:
Type of business:
Address:
Postcode:
Job title/type of work
Duties:
From (dd/mm/yy)
To (dd/mm/yy)
No. of days sickness absence in last 12 months:
Present/leaving pay	per
Reason you want to leave/have left:

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Please outline your skills and experience gained which are relevant to your application
for this job:

Referee 1
Name:
Company Name:
Address:
Telephone:
Referee 2
Name:
Company Name:
Address:
Telephone:

We will only take your conviction into account if the conviction is relevant to the role for which you are applying.

Do you have any unspent* criminal convictions?
Yes     No

EQUAL OPPORTUNITIES MONITORING FORM
The Company is committed to a policy of equality of opportunity and non-discrimination for all, both in its recruitment process and in the way in which it implements its employment practices. It is the Company’s policy to ensure that all employees are recruited, trained and provided with opportunities for promotion or development on the basis of their ability and taking account of the requirements of the job. No application for employment or employee will be treated less favourably than another because of age within statutory limits, colour, ethnic or national origin, nationality, religious belief, political affiliation, disability, gender or gender reassignment, marital status or sexual orientation. To ensure that this policy is operating effectively (and for no other purpose), the Company maintains records of employees’ and applicants’ ethnic origins, gender, marital status, disability etc. All applicants (internal and external) are requested to complete the section below. Thank you for your assistance.
GENDER
Male:
Female:

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MARITAL STATUS
Single:
Married:
Other:
ETHNIC GROUP
White:
Black African:
Black Caribbean:
Black Other:
Indian:
Bangladeshi:
Pakistani:
Chinese:
Asian Other:
Other:
AGE
18 and under :
19-29 :
30-39 :
40-49 :
50-64 :
65 and above :
DISABILITY DISCRIMINATION ACT
Please tick the checkbox if you consider yourself disabled within the meaning of the Disability Act 1995

DECLARATION

The information provided on this application form will remain private and confidential and will be used for the purpose of selection/ recruitment. Where the application is successful, the Company may from time to time thereafter, wish to process this information (as updated periodically) for personnel administration and business management purposes. Where this is the case, processing will take place in accordance with the the provisions of the Data Protection Act 1998. By signing this form, you will be providing the Company with your consent to these uses. I declare that to the best of my knowledge and belief, all particulars I have given are complete and true. I understand that any false declaration or misleading statement or any significant omission will result in disciplinary action, which may include termination of employment. I understand that any job offer is subject to references satisfactory to the Company and to a probationary period and, if the Company believes it appropriate, a satisfactory medical report.

I agree to the declaration stated above (Please tick to agree)