Position applied for:

Title:

Surname:

Forename(s):

Address:

Postcode:

Date of Birth:

Telephone:

Email:

NI Number:

Current Driving Licence:

Yes     No

Groups:

Expiry Date:

Details of Endorsements:

Are there any restrictions on you taking up employment in the UK?

Yes     No

If yes, please provide details:

Education History:

Schools:

Qualifications:

Colleges/Universities:

Qualifications:

Other training:

Employment History:

Notice required in current post:

Other Employment:

Please note any other employment you would continue 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.

Leisure:
Please note here your leisure interests, sport 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/Scottish Criminal Records Office.

General Comments:
Please detail here your specific reasons for this application, your main achievements to date and the strengths you would bring to this post.

Do you have a physical or mental impairment which has a substantial and long term effect on your ability to carry out day to day activities?

Yes     No

Please specify any special arrangements for work associated with any impairment:

Please specify any special arrangements you will need to attend an interview:

Please list any diseases, disorders, allergies, muscular or musculoskeletal injuries from you have suffered or do suffer:

Please detail any form of medicine, drugs or treatment you are currently and/or regularly receiving:

Please list all absences from work in the past 12 months and the reasons for such absences:

Declaration:
(Please read this carefully before sending application)

• 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.

• Should we require 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 the organisation reserves right the right to require me to undergo a medical examination. In addition, 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.

• I agree that should I be successful in this application, I will, if required, apply to the Criminal Records Bureau/Scottish Criminal Records Office 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.

Please enter I AGREE in the box below to signify that you agree with the declaration above.

Confirm Application: