Application Form







YesNo

If yes please give details of work or permit status:

Please give names and contact details of two or more referees that cover at least 5 years employment. Personal referees are acceptable if you have less than 5 years employment.

Please note any other employment you would continue if you were successful in obtaining this position.

Please note any criminal convictions except those ‘spent’ under the Rehabilitation of Offenders Act 1974. If none please state.

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


YesNo

If YES, please give details and specify any special needs in relation to your disability.

Please list any diseases, disorders, allergies, muscular or skeletal injuries from which you have suffered or do suffer.

Please detail any form of medicine, drugs or treatment you are / have taken currently / undergone in the last 5 years.

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






(Please read carefully before submitting this application)
  1. 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.
  2. I agree that the organisation reserves the right to require me to undergo a medical examination. (Should we require any 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).