Online Application

Position Applied For: Location:
Surname: Forename(s): Title:
Address:
Postcode: Telephone Number:
NI No. Email:
Current driving licence? Groups: Expiry Date:
Details of Endorsements:
Are there any restrictions on you taking up employment in the UK?
If yes, please provide details:
EDUCATION HISTORY
Schools: Qualifications gained:
Colleges/Universities: Qualifications gained:
Other training:
EMPLOYMENT HISTORY
NAME & ADDRESS OF EMPLOYER JOB TITLE / DUTIES: RATE OF PAY: START DATE: END DATE: REASON FOR LEAVING
Notice required in current post:
Please give details of the number of days’ and reasons for absence due to injury or illness in that you have had in the most recent 24 months of employment.
Have you been or are you subject to disciplinary proceedings, suspensions or expulsions by any regulatory or professional body or association in relation to your business or professional activities?
If yes please give details:
Have you ever been involved in an Employment tribunal?
If yes please give details:
OTHER EMPLOYMENT - Please note any other employment you would continue with if you were to be successful in obtaining this position:
REFERENCES
Please note here the names and addresses of two persons from whom we may obtain both character and work experience references.
1. 2.
LEISURE
Please note here your leisure interests, sports and hobbies, other pastimes etc.
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 / Disclosure Scotland.

GENERAL COMMENTS
Please detail here your reasons for this application, your main achievements to date and the strengths you would bring to this post. Specifically, please detail how your knowledge, skills and experiences meet the requirements of this role (as summarised in the person specification).
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 any 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 obtain 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 / Disclosure Scotland for a 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.
Signed: Date: