Please Complete the Form Clearly and Fully in Black Ink Or Typescript

Job Application Form

Please complete the form clearly and fully in black ink or typescript.

Application for Post of:
Personal Details
Title
Surname
Name(s)
Address
Home Telephone Number
Mobile Telephone Number
Daytime Telephone Number
Email Address
Nationality
National Insurance Number
Do you need a work permit to work in the UK
(Delete as appropriate) / Yes/No
Education and Professional Qualifications
(Original documents as proof will be required if appointed.)
Place of Study / Examinations taken / Qualification / Date Achieved
Professional Training Courses
(Please list any professional development you have undertaken which is relevant to the role you are applying for.)
Professional Memberships
Name of Professional Body / Type of Membership / Membership Number
Current or Most Recent Employment
Title of Post
Name of Employer
Employer Address
Dates Employed (From – to)
Salary and any benefits
Reason for leaving or intending to leave
Brief description of responsibilities
Notice required
Previous Employment
(Positions should be listed in date order, with the most recent first. Continue on a separate sheet if necessary.)
Title of Post
Name of Employer
Employer Address
Dates Employed (From – to)
Salary and any benefits
Reason for leaving
Brief description of responsibilities
Previous Employment (continued)
Title of Post
Name of Employer
Employer Address
Dates Employed (From – to)
Salary and any benefits
Reason for leaving
Brief description of responsibilities
Previous Employment (continued)
Title of Post
Name of Employer
Employer Address
Dates Employed (From – to)
Salary and any benefits
Reason for leaving
Brief description of responsibilities
Have you had any gaps in your employment history? If yes, please provide details:
Relevant Skills, Abilities, Knowledge and Experience
(Please state why you are applying for this post. Indicate past achievements, experience and personal qualities relevant to your application. Continue on a separate sheet if necessary.)
Other Information
(Delete as appropriate)
Do you hold a current driving license? / Yes/No
Do you own a car? / Yes/No
Disability Discrimination Act 1995
(Delete as appropriate)
Do you consider yourself to be disabled under the Disability Discrimination Act 1995? / Yes/No
If Yes, please provide further details
If selected for an interview, do you require any assistance to help you attend? / Yes/No
If Yes, what assistance do you require?
References
(One Referee must be your current/most recent employer.
Please advise if you do not wish us to contact your Referees prior to interview.)
Referee 1 / Referee 2
Title / Title
Full Name / Full Name
Relation to you / Relation to you
Job Title / Job Title
Company / Company
Address / Address
Telephone Number / Telephone Number
Email Address / Email Address
Declaration
I declare that the information given in this application form is true and complete. I understand that if I have given any misleading information or made any omissions, this will be sufficient grounds for terminating my employment. I consent to the processing by means of a computer database or otherwise any information I provide to the Micron Group for the purpose of employment, in accordance with Data Protection Act 1998.
Signature / Name
Date