AVAILABILITY Please specify your availability to work: Days Time From: Time To:
SUN
MON
TUE
How many hours would you wish to work per week?
WED
…………
THU
FRI
SAT
Could you work extra if required? Yes / No
EDUCATION & QUALIFICATIONS SECONDARY SCHOOLING, TECHNICAL, FURTHER OR UNIVERSITY EDUCATION Name & Address of Establishment
From
To
Examinations passed, with grades or Qualifications obtained
PRESENT & PREVIOUS EMPLOYMENT (Reference will not be taken up without prior approval) Employed From:
__ __ / __ __ / __ __ __ __
Name & Address of Employer:
To:
__ __ / __ __ / __ __ __ __
Leaving Salary/Pay: £ …………………
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………………………………….…………….………………………………………………………………………………………….. Nature of Business:
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Position Held:
Brief Description of Duties:
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Reason for Leaving:
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Employed From:
__ __ / __ __ / __ __ __ __
Name & Address of Employer:
To:
__ __ / __ __ / __ __ __ __
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Leaving Salary/Pay: £ …………………
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………………………………….…………….………………………………………………………………………………………….. Nature of Business:
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Position Held:
Brief Description of Duties:
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Reason for Leaving:
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OTHER EMPLOYMENT Please advise of us any other employment you would continue with if you were to be successful in obtaining this position: ………………………………….…………….………………………………………………………………………………………….. ………………………………….…………….………………………………………………………………………………………….. ………………………………….…………….…………………………………………………………………………………………..
MEDICAL HISTORY All our shop jobs require a reasonable degree of physical fitness be it standing and/or manual handling activities. Therefore please describe the level of physical fitness you believe you have: ………………………………….…………….………………………………………………………………………………………….. ………………………………….…………….………………………………………………………………………………………….. Have you suffered any serious illness or accidents, or are you receiving any medical treatment that may affect any employment with us? Yes / No. If Yes, please give details and dates: ………………………………….…………….………………………………………………………………………………………….. ………………………………….…………….………………………………………………………………………………………….. Are there any reasonable working adjustments you would need us to make to accommodate your health? Yes / No If Yes, please give details: ………………………………….…………….………………………………………………………………………………………….. ………………………………….…………….…………………………………………………………………………………………..
Please be advised that any employee or potential employee may be required to attend a medical examination/health assessment.
REFERENCES If you have no previous employment, please give details of who to contact for a personal or educational reference. Reference 1 Reference 2 Name:
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Occupation:
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How do you know them?
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Address?
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Telephone and/or Email?
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DECLARATION The details described in this application and any supporting information is, to the best of my knowledge, true and complete. I understand that giving false information or failing to disclose relevant information may later render me liable to summary dismissal if I take employment with the Company. Due to the nature of the work and easy access to cash I also declare that I have no criminal convictions except those 'spent' under the Rehabilitation of Offenders Act. In the event that I have a conviction record I have provided information about all previous convictions on a separate piece of paper attached to this application marked private and confidential. I also understand that the Company is permitted to hold personal information about me as identified on this application form as part of its personnel records and may disclose such information to third parties as part of the recruitment process. This applies to information held, used or disclosed in any medium.
