APPLICATION FOR EMPLOYMENT

Head Office: Road Range Solutions Ltd

Rathbone Road, Wavertree,Liverpool

Tel: 0151 330 7000 Fax: 0151 282 8800

Application for the post of: / Department:
Location: / Closing Date:

PERSONAL DETAILS

Surname: / Forename: / Title:
Address and Postcode:
Telephone Number (home): / Telephone Number (mobile): / National Insurance Number:

DRIVING LICENCE

Do you hold a full, current UK licence?
(Please tick) / Yes / No / Provisional
How long have you held this for? / Do you have your own transport: / Yes / No
Do you have any endorsements? / Yes
/ No / If yes, please give full details:
QUALIFICATIONS / TRAINING / EXPERIENCE (Detail any qualifications, training or experience relevant to the post applied for, giving dates. Continue on a separate sheet if necessary).
Details / Date
EMPLOYMENT HISTORY * (Most recent first)
Employers Name: / Telephone Number:
Position Held: / Nature of business:
Address: / Main Duties (do not complete if a CV has been attached)
Employed from: / Employed to:
Salary: / Notice Period Required:

* Not necessary to complete this section if a CV has been submitted PA 03 02

PREVIOUS EMPLOYMENT *

Employers Name: / Telephone Number:
Position Held: / Nature of business:
Address: / Main Duties (do not complete if a CV has been attached)
Employed from: / Employed to:
Starting Salary: / Final Salary:
Reason for Leaving?
Employers Name: / Telephone Number:
Position Held: / Nature of business:
Address: / Main Duties (do not complete if a CV has been attached)
Employed from: / Employed to:
Starting Salary: / Final Salary:
Reason for Leaving?
Employers Name: / Telephone Number:
Position Held: / Nature of business:
Address: / Main Duties (do not complete if a CV has been attached)
Employed from: / Employed to:
Starting Salary: / Final Salary:
Reason for Leaving?
Please give details of any time not accounted for elsewhere on this application form

SOCIAL ACTIVITIES

Please give details of any pastimes / hobbies:

CONVICTIONS

Do you have a criminal record (excluding spent convictions)? Please disclose court martial conviction, outstanding summonses or prosecutions
Date: Nature of Offence: Sentence of court order with costs:

PA 03 02

WORK

If offered a position would you continue to work in any other capacity i.e. part-time work? please tick Yes No
If yes please give details:
Do you have any other commitments, which might affect your working hours? i.e. Judicial, Military or Local Government.
Yes No If yes, please give details:

Are you entitled to take up employment in the UK? Please tick Yes No
If you answered ‘yes’ and this is dependent on a work permit/visa, please give the date this expires.
Expiry Date: / / (dd/mm/yyyy)
Please note that the Asylum and Immigration Act 1996 requires employers to obtain documentary evidence from new employees of their entitlement to work in the UK. You should therefore be aware that you will be asked to provide this evidence on your first day of work.
Have you ever been dismissed from employment? Please tick Yes No Details:
What is the earliest date you will be available for employment: Expected Salary: £
Please give dates of any holidays booked:
The Disability Discrimination Act 1995 (DDA) defines a disability as a "physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is likely to last, over 12 months. Do you consider yourself to have a disability under the DDA (please tick)?
Yes No
Used to have a disability but have now recovered Don't know
Prefer not to say
If you answered "Yes" to the above question, please give brief details of your condition and please indicate whether you may require any adjustments to enable you to attend and participate in an interview or to carry out any selection tests. Disabled applicants are invited to contact the personnel office in confidence at any point during the recruitment process to discuss steps that could be taken to facilitate attendance and participation at an interview or in order to overcome any operational difficulties presented by the job.
Brief details of condition (including whether mental or physical):
......
Adjustments required for interview (including, for example, induction loop/radio aid/speech—to—text reporter/BSL interpreter/other):......
Adjustments required for job:......
Please give details of any other special requirements we may need to be aware of in order to facilitate your attendance at an interview.
REFERENCES (Present employers will not be contacted, without your consent, unless an offer of employment has been made and accepted)
Please supply the name and address of 2 references, if you are unemployed please give the name and address of the Unemployment Benefit Office and the dates registered (please note personal references will only be accepted from someone in a professional capacity NOT a relative or friend)

Present/Most recent employer

Name:
Full Address:
Postcode:
Tel:
Position/Title: /

Previous Employer

Name:
Full Address:
Postcode:
Tel:
Position/Title:
NOTES
1) All questions should be answered. If employment is offered and accepted, employees are required to notify their Manager, within 7 days, of any changes to the above information.
2) It is the Company’s policy to employ the best qualified and suitable personnel and provide equal opportunity for the advancement of employees, including promotion and training, and not to unjustifiably discriminate against any person because of race, colour, sex, national or ethnic origin, disability, sexual orientation, religious belief or age.
3) It is the Company’s intention to ask for references. All appointments are made, subject to receipt of references, which are satisfactory to the Company.
4) All appointments are made on the express provision that the employee will agree at any future time to undergo a medial examination by their own doctor or doctor appointed by the Company.
5) All employees are required to satisfactorily complete a designated probationary period of 6 months during which time employment can be terminated, without following the company’s disciplinary procedures, if deemed unsuitable.
6) Where employment is accepted, subject to the granting of any required qualifications or work permits, the contract shall be nullified in the event of non-conformance.
DATA PROTECTION STATEMENT
In accordance with the Data Protection Act 1988, you should be aware that the personal details submitted with this application form will be used only for selection/interview purposes and for employment records of the applicant if successful.
The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. The personal information that you give us will also be used in a confidential manner to help us to monitor our recruitment process.
If you succeed in your application and take up employment with us, the information will be used in the administration of your employment with us and to provide you with information about us or third parties via your payslip. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process.
We may check the information collected with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law.
By signing this application form you consent to the processing of sensitive personal data (as described above), in accordance with our registration with the Data Protection Commissioner.
DECLARATION
I declare to the best of my knowledge all the information contained in this application form and supporting documents is true and correct. I understand that if it is found that I have deliberately given false or misleading information, I will, if appointed, be liable to summary dismissal.
Signed:
Print:
Date:

PA 03 02

ISSUE NO. 3 P-A-03-02