Application form

Title

First Name

Last Name

Maiden/Former Names

Date Of Birth

Place Of Birth

Country Of Birth

Home Telephone Number

Mobile Telephone Number

National Insurance Number

Email Address

Current Address

Previous Address 1

Previous Address 2

Previous Address 3

Previous Address 4

Previous Address 5

Previous Address 6

Person To Be Contacted In An Emergency

Relationship

Home Telephone Number

Mobile Telephone Number

Address

Do you hold a full/provisional driving license?

YES NO

State any driving conviction in the past five years

Are you subject to Immigration Control

YES NO

If yes, do you have an unrestricted entitlement to take up employment in the UK?

YES NO

Have you, ever been fined, cautioned, sentenced to imprisonment or placed on probation for a criminal act (subject to the Rehabilitation of Offenders Act)?

YES NO

Are there any alleged offences outstanding against you?

YES NO

If yes, please give details

Have you ever been made bankrupt or have Court Judgements against you, whether satisfied or not, within the last 6 years?

YES NO

Has any order been made against you by a Civil or Military Court or Public Authority?

YES NO

If yes, please give details

Five Year Employment History Starting with your last or present employer, give details of your employment history, for the last five (5) years or since you left full time education. If you have been unemployed and have been registered with an employment service office, such as the Job Centre, please gain written confirmation of this at your earliest convenience. This can be done by calling 0345 608 8545, press option 2, and ask for a ‘Proof of Benefit Letter’ to be sent to you. Attach below.

If leaving the military please attach your certificate of discharge.

Are You Self Employed?

Name of company/job centre/College:

Telephone

Address

Position Held

Reporting to

Basic Wage

Notice required for leaving

Date From

Date To

Name of company/job centre/College:

Telephone

Address

Position Held

Reporting to

Basic Wage

Notice required for leaving

Date From

Date To

Name of company/job centre/College:

Telephone

Address

Position Held

Reporting to

Basic Wage

Notice required for leaving

Date From

Date To

Name of company/job centre/College:

Telephone

Address

Position Held

Reporting to

Basic Wage

Notice required for leaving

Date From

Date To

Name of company/job centre/College:

Telephone

Address

Position Held

Reporting to

Basic Wage

Notice required for leaving

Date From

Date To

Name of company/job centre/College:

Telephone

Address

Position Held

Reporting to

Basic Wage

Notice required for leaving

Date From

Date To

Please nominate a person who has known you for at least two (2) years immediately prior to the commencement of the screening process. The character referee should not be a previous employer, relative (by blood or marriage) and/or persons residing at the same address as you. This person should not be related to you but may be a current or previous colleague.May we approach your employer(s)?

YES NO

Referance 1

Reference 1

Reference 2

School/College/University

Dates From

Dates To

Exams taken/Qualifications gained

School/College/University

Dates From

Dates To

Exams taken/Qualifications gained

School/College/University

Dates From

Dates To

Exams taken/Qualifications gained

First Aid Qualification

YES NO

Foreign Languages

DECLARATIONS I certify that to the best of my knowledge, the information that I have given in my application for employment is true and complete and understand that any false statement or omission to the Company or its representatives may render lead to termination of employment without notice. I understand and agree that if so required I will make a Statutory Declaration in accordance with the provisions of the Statutory Declarations Act 1835 in confirmation of previous employment or unemployment. I authorise the Company or its agents to approach Government agencies, former employers, current employees, educational establishments, criminal justice agencies and personal referees for information relating to and verification of my employment/unemployment record. I consent to the Company’s reasonable processing of any personal information obtained for the purposes of establishing my medical condition and future fitness to perform my duties. I accept that I may be required to undergo a medical examination where requested by the Company. Subject to the Access to Medical Reports Act 1988, I consent to the results of such examinations to be given to the Company and authorize the Company to make a consumer information search with a credit reference agency, which will keep a record of that search and may share that information with other credit reference agencies. I further declare that any documents that I provide as proof of my identity, proof of address, proof of right to work and any other documents that I provide are genuine and give my consent for these documents to be examined under a UV scanner or similar device. I acknowledge that any falsified documents may be reported to the appropriate authority. DATA PROTECTION ACT 1998 The Company will use the information you have given on your application form (together with any information which we obtain with your consent from third parties) for assessing your suitability for employment. It may be necessary to disclose your information to our agents and other service providers. Your information will be viewed by agents employed by the company to check its compliance with BS 7858 Security Screening of Individuals Employed in a Security Environment and also for Audit Purposes. By returning this form to the Company you consent to our processing personal data about you where this is necessary, for example information about your credit status, ethnic origin or criminal offences. You also consent to the transfer of your information to your current and future potential employers where this is necessary (this may be to companies operating abroad if you apply for work outside of the United Kingdom). Your information will be held on our computer database and/or in our paper filing systems. By signing below you agree to this process and confirm that you do not have a criminal record subject to the current Rehabilitation of Offenders Act and any amendments. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected. DISCLOSURE You are applying for a position of trust and in the event of being offered employment by the Company we may apply for a Disclosure. However, having a criminal record does not necessarily bar you from employment. For more information ask a member of staff for a copy of the CRB Code of Practice/Disclosure Scotland and/or Company our policy statement regarding ex-offenders. Disclosure information is treated in a sensitive way and is restricted to those who need to see it to make a recruitment decision. By signing this document you allow the Company to see a copy of the Disclosure. The Disclosure information is not retained i.e. it is disposed of within the timescales recommended in the CRB Code of Practice. By signing below you agree to this process. SCREENING Any offer of work is subject to satisfactory screening, that the applicant consents to being screened and will provide information as required. That the information provided is correct, and the applicant acknowledges that any false statements or omissions could lead to termination of employment.

I HAVE READ THE ABOVE

Name

Signed

Date

Office Use Only