Arclid Transport Ltd

Private and Confidential

ARCLID TRANSPORT LTD

ARCLID QUARRY, CONGLETON ROAD, SANDBACH, CHESHIRE, cw11 4sn

Tel: 01270 767596 Email:

______

STAFF APPLICATION FORM

Position Applied For ………………………………………………………………………………......

PERSONAL

Surname: (Mr Mrs Miss) …………………………………………………………………………….

First Names: ………………………………………………………………………………………….

Address: .…………………………………………………………………………………………

…………………………………………………………………... Tel No: …………………………

Date of Birth: ………………………………………... Nationality: …………………………………

Marital Status: ………………………………………. No. of children ……………………………

Do you hold a current driving licence? Yes / No

Driving convictions, if any, in the last 10 years:

……………………………………………………………………………………………………......

………………………………………………………………………………………………………...

MEDICAL

Do you suffer from any kind of physical or medical disability? Yes / No

If yes, please state details: ………………………………………………………………………….

………………………………………………………………………………………………………...

Are you Registered Disabled? Yes / No If yes, please state registration number: ……………….

What serious illnesses or operations have you had in the last 10 years? ………………………………..

…..……………………………………………………………………………………………………

Are you prepared to undergo a medical examination? Yes / No

EDUCATION & TRAINING

Senior School(s) attended / From / To / Examinations taken
(subjects and grades attained)
Universities / Colleges / From / To / Subject / Qualification
Other Professional Qualifications / Dates
Membership of Professional / Technical Associations

NOTE: All engagements are subject to satisfactory references being obtained. No communication, however, will be made to your present employer until you have been provisionally accepted for employment.

EMPLOYMENT HISTORY

Name and full address of Employers / Period of
From to / Occupational and brief description of duties / Reason for
leaving
1. Present or last Employer / Salary: £
2. Previous Employers
Please indicate salary expected £ When would you be available to take up a
new appointment?

Names and addresses of two people to whom reference may be made:

Name: ……………………………………… Name: ……………………………………….

Address: ……………………………………. Address: ……………………………………..

……………………………………. ……………………………………..

Telephone No.: …………………………….. Telephone No: ………………………………

Profession: ……………………………. Profession: ……………………………….

ADDITIONAL

Hobbies and interests (please give details) …………………………………………………………….

………………………………………………………………………………………………………...

Any specific experience or further information you think may be relevant to this position:

………………………………………………………………………………………………………...

Recruitment policy: It is the company’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, national origin, sex or marital status.

I authorise the company to obtain references to support this application once an offer has been made and accepted and release the company and referees from any liability caused by giving and receiving information.

Declaration: I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.

Signature …………………………………………… Date ………………………………………

FOR OFFICE USE:

Date interviewed / By whom / Remarks