Position applying for*
Location/Site (if known)
Where did you hear about the job?*
IndeedJob CentreOur websiteFriends/familyWord of mouthOther
Please Specify
Title*
MrMrsMissMsOther
First Name*
Surname*
Home Address*
NI Number
UTR No.
Mobile Number*
E-Mail*
What is your ethnic origin?*
WhiteWhite OtherBlack CaribbeanBlack AfricanBlack OtherAsianIrishOther
Please Specify Other
Gender*
MaleFemaleTransgenderNon-binaryPrefer not to say
Age Range*
16-2425-3435-4445-5455-6465+
Do you have a disability within the meaning of the Disability Discrimination Act 1995 (this means any physical or mental impairment which has lasted or is expected to last at least twelve months, and which substantially affects your ability to carry out normal day to day activities)?* YesNo
Medical Details: Have you suffered or do you suffer from any medical condition which would need to be considered?* YesNo
Please provide details of your last two employers from present to first in that order. Previous employers will not be approached without applicant’s permission.
Date From
Date To
Name of employer
Brief details of duties with Position held
Salary/Hourly Rate
Name
Tel
Email
Company
Passport/Driving Licence/ID Card
Proof of Address (Utility bill within 3 months)
Bank Statement
CSCS/CPCS Card
Any other relevant document/certification
Confidential
The information provided on this form will be used as part of our recruitment process to assess your capacity to perform the role which you have applied for.
Certain information (for example relating to your age, gender, race/ethnic and national origins, disability, sexual orientation, religious or philosophical beliefs) may be used in the statistical format in order that we can assess and report on equality and diversity in our recruitment process but will not be made available to the individual responsible for the recruitment decision.
If you are successful in your application then the information provided in this form will be kept on your personnel file. If your application is unsuccessful then we will keep this information for a period of 6 months after the recruitment decision has been made.
For more information on your data protection rights in relation to your application please refer to our Data Protection Privacy Notice – Employee Information, which is available on request or in our Employee Handbook.
Declaration
I declare that all information given in this application form is true and complete. I understand that if I have given any misleading information on this form or made any omissions, this will be sufficient grounds for terminating my employment
Name:
Date:
All (Sensitive) Personal Data recorded on this form will be used for the purposes of recruitment and employment only and in accordance with the Data Protection Act 2018 and will not be distributed to third parties except with your consent.
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