ࡱ> 7 BbjbjUU %7|7|cl4444444H F F F8BF NFHHiH6I6I(^I^I^I^I^I^Ihhhhhhh$j lh4^I^I^I^I^Ih L44^I^Ii L L L^I64^I4^Ih L^Ih L LRS44/S ^I*I !HA FJ.S;Si0Hi'S2mJH2m;S LHH4444Application for Employment PRIVATE AND CONFIDENTIALPlease complete in BLOCK CAPITALSJob Reference Number:Applicant Reference Number:Position applied for:How did you hear of this vacancy? (include date)A. PERSONAL PARTICULARSFull Name: Mr/Ms/Mrs/MissAddress:Telephone Number (including STD Code)Home:Mobile:Business:(Tick box if you do not want to becontacted at work).Applicants will be required to provide documentary e-mail address:evidence of their right to work in the United Kingdomif invited for interview.N.I. Number:Do you have the right to work in the UnitedKingdom?Yes/No B. EDUCATION AND QUALIFICATIONS QUALIFICATIONS: Please give details of examinations attempted and results (including any examinations failed) Name(s) and Address(es) of School(s)/College(s)DatesSubject/Courses Studied & LevelExamination Result/ Grade (include any examinations failed)FromTo FURTHER AND HIGHER EDUCATION: Please give details of all further and higher education since leaving school including training courses and details of qualifications. University/College/ Institute AttendedDatesSubjects Studied Type of TrainingQualifications ObtainedFromTo PROFESSIONAL ASSOCIATIONS: Please state whether you are a member of any technical or professional association, and if so, which: FOREIGN LANGUAGES: Please list any foreign languages you speak and your level of competence, both oral and written:  C. EMPLOYMENT HISTORY Please list starting with the most recent, all the organisations for which you have worked during the last 20 years: Name(s) and Address(es) of Employer(s)DatesPosition Held/ Main DutiesStarting/ Leaving SalaryReason for LeavingFromTo D. HEALTH Are you in good health? If No, please give further information: Yes / NoHave you ever suffered from any serious illness or had any major operation? If Yes, please give details: Yes / NoAre you prepared to undergo a medical examination prior to employment? Yes / No E. SUPPLEMENTARY INFORMATION Please give details of any experience, skill or achievements which you feel may be relevant in your application for employment. (Continue on separate sheet if necessary).  Please give dates of any holidays arranged:Are you currently subject to any contractual "restraints of trade" clauses?Yes / NoIf Yes, please give further information:Do you have any commitments which might limit your working hours?Yes / NoIf Yes, please give details:Are you willing to work overtime and weekends when required? Yes / NoHave you ever been convicted of a criminal offence: (which is not a spent conviction under the Rehabilitation of Offenders Legislation).Yes / NoIf Yes, please give further information:Salary Range Expected:How much notice are you required to give to leave your present employment?Have you worked for us before?Yes / NoIf Yes, give details of reason for leaving:Please list your interests, sports, hobbies, etc.Do you have a current full driving licence?Yes / NoDoes your licence have any current endorsements?Yes / NoIf Yes, please give further information: F. REFERENCES Please give the names and addresses of two referees who are not related to you, who we can approach for a confidential assessment of your suitability for this job. (One of these must normally be a previous employer). Can we approach your present/most recent employer? Yes / No (Tick in box if you do not wish your employer to be contacted before an offer of employment is made) Name, Position, Address and Telephone NumberName, Position, Address and Telephone Number DECLARATION OF APPLICANT I confirm that the above information is correct. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable for dismissal. I consent to the Organisation using and keeping information I have provided on this application or elsewhere as part of the recruitment process and/or personal information supplied by third parties such as referees, relating to my application or future employment. I understand that the information provided will be used to make a decision regarding my suitability for employment and if successful the information will be used to form my personnel record and will be retained for the duration of my employment. If I am not successful, I understand that the Organisation will retain the form for as long as is deemed necessary and that the Organisation may use it to contact me in the event of there being any other vacancies for which I may be suitable.Signed:Dated: FOR OFFICE USE ONLYINTERVIEW RECORDInterviewed by:Date:Comments/Areas to Examine:Decision:RejectFurther InterviewAccept(Tick as applicable)Interviewer's report and reasons for decision:Rejection letter sent:Yes / No APPOINTMENT RECORD (To be completed where there has been an offer of employment).CONDITIONAL OFFER LETTER Date sent: Response: Acceptance/Refusal/No replyREQUESTS FOR REFERENCES Date sent: Response: Good/Satisfactory/No Reply/Suspect/UnsuitableMEDICAL/MEDICAL REPORT Date sent: Response: Good/Satisfactory/Suspect/UnsuitableRIGHT TO WORK IN U.K. Appropriate documentary evidence checked.Starting Date: Starting Salary:Grade:Job Title: Personnel/Clock Number:  Appendix PAGE \* MERGEFORMAT 4 of  NUMPAGES \* MERGEFORMAT 4 Rev VerApplicat 4 1 VD E E [  ( @ ] -8% !"#-.=BCJOJQJmHnHujOJQJUOJQJCJ0J'4VWmn$IfD$$Ifl0##$64 la$IfAZ`4$$Ifl4#G$64 la$Ifj$$Ifl\ #  i 64 la>D$$Ifl0,#64 la2$$Ifl4#G$64 la$IfD$$Ifl0b#y64 laBdl`2$$Ifl4#G$64 la2$$Ifl4#G$64 la$If2$$Ifl4#G$64 la BCDEFGMNOPQRZ[ q q q(q D$$Ifl0##$64 la$IfD$$Ifl0##$64 la [\]^_ijk0`D$$Ifl0##$64 la$If  ID$$Ifl0##$64 la$Ifk$$Ifl4\<## h764 la&'(BopE$$Ifl40##$64 la$IfD$$Ifl0##$64 laBCDEFS oE$$Ifl40##$64 la$IfD$$Ifl0##$64 la"HSQQQQW$$IflF##  6    4 la $$Ifa$$IfE$$Ifl40##$64 la "#;SYjzd0$$Ifl4\ l#`D $ `p`o064 la$If M$$Ifl4r jl# D  p o064 la$If$IfU$$Iflr jl#D po064 la$If [UUUUU[UU$If$$Iflr jl#D po064 la U$$Iflr jl#D po064 la$If [UUUUU[UU$If$$Iflr jl#D po064 la U$$Iflr jl#D po064 la$If [UUUUU[UU$If$$Iflr jl#D po064 la USQKK$If$$Iflr jl#D po064 la$If       f0```$If$$Ifl4\ l#`D $ `p`o064 la$If        YSSSSS$If$$Ifl4r jl# D  p o064 la ! 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