o
APPLICATION
FORM
Please attach a Passport photograph to the top right hand corner of this form.
You MUST complete this form in BLACK or BLUE ink using BLOCK CAPITALS.
You MUST complete ALL sections of this form.
POSITION APPLIED FOR
SECURITY MANAGEMENT / MOBILE SECURITY TEAM / TRACK SECURITY OFFICERSECURITY GUARD / OTHER
SECTION A: Personal details
Title (tick box)
Surname
First name
Middle name/s
Have you ever been known by a different name? If ‘No’, go to Address (below)
Previous name/s
Date of change/s D D M M Y Y Y Y
Address
Town/City Postcode
Country
Home Phone
Mobile
Gender
Date of birth D D M M Y Y Y Y
Place of birth (country/city)
Nationality
Do you require a work permit to work in the UK? If ‘No’, go to Section B
Permit number
Permit expiry date D D MM Y Y Y Y
National Insurance No
SECTION B: Person to contact in an emergency/Next of Kin
Full Name
Address (in short, eg street & postcode)
Home phone
Work phone
Mobile
Relationship eg, son, mother, friend, etc
SECTION C: Payment details
Account Holders Name
Bank Name
Sort Code
Account Number
Ref/Other
SECTION D: Screening details
Do you hold a valid UK Driving Licence? Yes No
Do you have your ‘own transport’? Yes No
Car Motorcycle Other
Driving Licence number
Have you ever been disqualified from driving? Yes No
Any motoring convictions or endorsements (last 5 years)? Yes No
Have the Police ever cautioned you? Yes No
Ever been convicted, fined or had any order made against you? Yes No
Have you ever been declared bankrupt or insolvent? Yes No
Are you the subject of any Court Judgment or proceedings? Yes No
If ‘Yes’ to any of the above:
Date / Description / Outcome
SECTION E: Personal references
1 / Title
Name
Address
Postcode
Phone
Time known (Years & Months)
2 / Title
Name
Address
Postcode
Phone
Time known (Years & Months)
SECTION F: Employment/Education/Personal History (last 5 years)
Dates From - To / Name & Address, Postcode, Contact details / Position held / Job desc
SECTION G: Formal education/Qualifications
School/College / Qualification/Awarding / Body Date
SECTION H: SIA Licences
Type/Sector / Number / Expiry
SECTION I: Working hours
Are there any factors relevant to your ability to do this job which may affect your availability to work at any time, including nights and weekends? / Yes/No
If ‘Yes’, please give details
SECTION J: Health/Disability
Do you have a disability or a health problem that may affect
the kind of work you are applying for? / Yes/No
If ‘Yes’, please give details
SECTION K: Declaration
I declare that the information given on this form is, to the best of my knowledge, true, accurate and complete.
I have no criminal convictions other than any treated as spent under the provisions of the Rehabilitation of Offenders Act 1974 and those disclosed on this application form.
I understand that any misrepresentation of the facts is a ground for refusal of employment or disciplinary (and possibly criminal) proceedings.
I hereby authorise the Company to seek reference information based on the details provided by me. I also understand that this information received by the Company will remain confidential and will not be made available to me.
I authorise the Company to make a consumer information search with a credit reference agency, which will keep a record of that search and may share that information with other credit reference agencies.
I understand that in the course of the Companies screening processes I may be required to obtain a Statutory Declaration at my own expense in accordance with the Statutory Declarations Act 1835, in confirmation or previous employment or unemployment.
I understand that any offer of employment is subject to satisfactory screening results and if I am unable to satisfy any of the screening processes my employment contract will be terminated.
I acknowledge that no contractual relations will exist until such times as I have accepted in writing the terms of a letter of appointment or signed a form of contract.
Signed Date / /
SECTION L: Proof of identity and Address of Residence-
Please supply with this application form COPIES of either:
1 Two identity documents from group A. At least one document must show your current address and at least one document must show your date of birth.
Or
2. One identity document from group A and 2 documents from group B. At least one document must show your current address and at least one document must show your date of birth.
Group A Documents: Tick if enclosed
• Signed valid Passport of any nationality.
• Signed UK photo driving licence (both parts of the full or provisional licence are required).
• Valid and current Security Industry Authority (SIA) licence.
• UK original birth certificate issued within 12 months of birth.
• UK adoption certificate.
Group B Documents: Tick if enclosed
• Valid EU photo ID card.
• Valid UK firearms licence with photo.
• Signed UK paper driving licence.
• Marriage certificate or Civil Partnership certificate, with translation if not in English.
• UK birth certificate issued more than 12 months after date of birth.
• Non-UK birth certificate, with translation if not in English.
• P45 statement of income for tax purposes on leaving a job issued in the last 12 months.
• P60 annual statement of income for tax purposes issued in the last 12 months.
• Bank or building society statement issued to your current address, less than three months old. You can use more than one statement as long as each is issued by a different bank or building society.
• Mortgage statement issued in the last 12 months.
• Utility bill (gas, electric, telephone, water, satellite, cable, mobile phone contract) issued to your current address within the last three months. You can only use one utility bill.
• TV licence in your name and current address issued in last 12 months.
• Pension, endowment or ISA statement issued in last 12 months.
• Certificate of British nationality.
• British work permit or visa issued in last 12 months.
• Letter from H.M. Revenue & Customs, Department of Work and Pensions, employment service, or local authority issued within the last three months. You can use more than one letter as long as each is issued by different Government department or different local authorities.
• A credit card statement sent to your current address within the last three months. You can use
more than one statement as long as each is issued by a different issuer.
• Council Tax statement issued in the last 12 months.
• Court summons issued in last 12 months.
• Child benefit book issued in last 12 months.
• A payslip, with your address and the employer's name or logo, that is less than three months old.
MARCH 2015/V2 / 1