Job Application

Post applying for: Job title
I heard about the job through: Advertisement (please state which newspaper etc. below) Website (which one) Job Centre (which one) Shop window (which one) Other source (which one)
Please give further info:
Personal details: Title
Surname
Forenames
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone (home)
Telephone (mobile)
Email
Relevant qualifications or professional membership Examination level and Subject(s) (eg GCSE/ ‘A’ Level / Degree/ NVQ)
Present or most recent employment Employer's name and type of establishment
Employer's address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Employer's telephone
Job Title
Date started in post
Notice required
Date left if no longer employed
Reason for leaving
Briefly describe your main duties and responsibilities in the above job.
Please state you present salary
Past employment: Please give details of all your previous work experience, putting the most recent first. Include any voluntary or unpaid work. - Employer's name and address - Dates employed from/to month/year - Job held and brief outline of duties - Reason(s) for leaving
Training - Course title or area of training relevant to this post - Date
Additional information After reading the job description please say why you are applying for the post and tell us how you meet the requirements of the job. Highlight any knowledge, experience and skills that you consider relevant to the post you are applying for. CVs are not accepted as a substitute for completing this section. If you wish to provide further information, please do so in the space provided below.
Work permit: Do you require a work permit? Yes No
Driving: (only complete this section if driving is required as part of the role) Do you hold a current full driving licence? Yes No
Do you have any current driving convictions? Yes No
If yes please state convictions
Health and general attendance: Please give details of the number of days and occasions you have been absent from work in the past two years as a result of ill health.
Please give details of any illness that has caused you to be absent from work for 10 or more consecutive days during the past two years.
Smoking Please state if you are a smoker? Yes No
Holidays: Please state if you have holiday scheduled? If so please provide dates.
References Please give the names and addresses of two referees (not friends or relatives). You should ensure that personal references are not used. Where you have been unemployed or not working for a period of time it is helpful if references can be given from voluntary work/school groups or committees. Referee 1: This should be your current or most recent line manager. Referee's name
Referee's job title
Referee's address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Referee's telephone
Contact before interview? Yes No
Referee2: This should be a previous employer. Referee's name
Referee's job title
Referee's address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Referee's telephone
Contact before interview? Yes No
Criminal convictions Do you have any criminal convictions? Yes No
If yes please give details, this should exclude any spent convictions under Section 4(2) of the Rehabilitation of Offenders Act 1974, unless the job for which you are applying involves working with vulnerable adults or children in which case cautions, bindovers, pending prosecutions, spent and unspent convictions must be declared.
Declaration In accordance with the Data Protection Act 1998, the information provided on this form will be used in the recruitment and selection process and may be disclosed to all those who need to see it. It will also form the basis of the confidential personnel record of the successful candidate. In the case of unsuccessful candidates the Application Form will be destroyed after six months. I understand that any false statements could result in my dismissal if appointed. I confirm that I am legally eligible to work in the United Kingdom. I hereby declare that to the best of my knowledge, all the information given by me is correct, and that I possess all the qualifications I have listed on this form. I agree that the employer has the right to validate any of the information provided.
EQUAL OPPORTUNITIES MONITORING FORM One of the aims of this policy is to ensure that discrimination on the grounds of race or sex, or disability is avoided. To ensure that this policy is fully and fairly monitored would you please complete this form. The information collected will form a confidential statistical record which will not be used for any purpose other than the employers policy on Equal Opportunity.
Date of birth / MM / DD YYYY
Please tick the box which most closely describes you Male Female
Please tick the boxes which most closely describe you White - British White - Irish Other White Background Black or Black British - Caribbean Black or Black British - African Other Black Background Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Chinese or other Ethnic background - Chinese Other Asian Background Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Other Mixed Background Other Ethnic background
Disability Definition: The Disability Discrimination Act 1995 defines a disabled person as one who has physical or mental impairment which has substantial and long term adverse effect on his/her abilities to carry out normal day to day activities. Do you have a disability? Yes No
If yes, what is the nature of your disability: