Autoline Insurance Group Limited - Application Form
Position: Customer Services Advisor
Reference: PL/CSA/C/06/17/
Please note only application forms containing all the information which has been sought on the Application Form will be considered for appointment. No other additional information, including CVs will be considered.
The completed application form and Equal Opportunities Monitoring Questionnaire should be returned to the following address:
The Human Resource Manager
Autoline Insurance Group Ltd
Unit 2, Ashtree Enterprise Park,
Rathfriland Rd,
Newry,
County Down BT34 1BY
Please complete this form clearly in type or black ink and return it to the address shown above.
How did you find out about this position?
1. Personal DetailsTitle / (Mr/Mrs/Miss/Ms/Dr/Other)
Gender / (Male | Female)
First Name
Surname
2. Contact Details
Home Address
Postcode
Home Phone Number
Mobile Number
3. Other Personal Details
Citizenship(s)
UK National Insurance Number, (NI)
Do you require a work permit to work in the UK? / Yes | No
If you answered "Yes" to the above question, have you been granted a work permit? / Yes | No
Please provide details (i.e. eligibility dates and registration number of your work permit)
If you are from elsewhere within the EU/EEA, hplease confirm that you have registered details of your employment with the Home Office? / Yes | No
Do you hold a full current UK driving licence? / Yes | No
Please note, if you are successful, you must provide appropriate copies of official documents as evidence to company.
4. Employment and Salary Requirements
Please specify your current salary / £ per annum
Current Notice Period
Date you are available from
5. Educational and Professional Qualifications
In the space below please outline your educational and professional qualifications. Please start with your most recent education and qualifications.
(You should include dates for each school and qualifications and grades obtained; please use a additional sheet of paper if there is insufficient space)
Education Level (e.g. secondary school) / Qualifications Attained
Please specify the level of the qualification (eg NVQ Level 3 ICT)
Specify subjects for secondary school only Overall qualification title will suffice for 3rd level) / Grades
Please note that proof of training and examinations will be sought / Dates (e.g. month of examination sat or date of graduation)
e.g college / NVQ Level 3 ICT / Merit / June 2008
6. Employment History
Please list your last three jobs starting with your current or most recent employment (please continue on a separate sheet if necessary):
(1) Employer's NameEmployer's Address
Job Title
Main Duties and Responsibilities
Your Achievements
Start Date
End Date
Reason for leaving
Salary
(2) Employer's Name
Employer's Address
Job Title
Main Duties and Responsibilities
Your Achievements
Start Date
End Date
Reason for leaving
Salary
(3) Employer's Name
Employer's Address
Job Title
Main Duties and Responsibilities
Your Achievements
Start Date
End Date
Reason for leaving
Salary
7. Key Skills
Please outline your relevant skills for this post in particular demonstrating how you meet the Essential and Desirable Criteria in the advertisement for this position.
(Please use an additional sheet of paper if there is insufficient space)
Please note: applicants unable to demonstrate sufficient evidence required to meet the Essential Criteria will not be short-listed for interview.
Essential Criteria
Desirable Criteria
8. Attendance Record
Please state how many days you have been absent from work, (other than authorised holidays) during the past 12 months / day(s)
Give reasons for any absence
9. Additional Personal Information
Please tell us about yourself, your interests, hobbies and sports
10. Vocational Training
Please give details of any vocational training or work related training/Continuous Development Training that you may have gone through with previous employers
11. Criminal Offences
Do you have any previous criminal convictions, which are not "spent" under the Rehabilitation of Offenders Act 1974? / Yes | No
12. Disability
Do you have a disability, long-term condition, or a recurring medical problem? / Yes | No
If Yes, what arrangements, if any, can we make for you to participate fully in the recruitment process and to undertake the position for which you are applying?
13. References
Please give names and addresses of two referees who can confirm your ability to meet the responsibilities of the job for which you are applying. Where possible one of the referees should be your present or most recent employer.
Please note that the provision of referees is not necessary for applicants already in the employment of Autoline Insurance Group.
Referee One / Referee Two
Name / Name
Position / Position
Address / Address
Telephone / Telephone
Mobile / Mobile
Fax / Fax
Email / Email
Relationship to applicant / Relationship to applicant
Please note that references are usually sought before any position is offered. However, we will not contact the above referees without your prior knowledge.
14. Data Protection Notice
The information gathered from this application form will be held by the organisation in accordance with the Data Protection Act 1998 and for the purposes described in the organisation’s entry on the Data Protection Register.
As an applicant you are entitled to request such data and other information relating to your application and/or selection from the organisation.
15. Declaration
By completing this declaration, I consent to the collection, recording and use of the information, which I have provided in the way described above. I declare that to the best of my knowledge and belief all the information I have given on this form is correct and can be treated as part of any subsequent contract of employment
Signed
Date
[Please keep on separate page from application form]
Equal Opportunities Monitoring Questionnaire Ref No: _____
Autoline Insurance Group Limited is an Equal Opportunities Employer. Our aim is to ensure that no job applicant or employee receives less favourable treatment on the grounds of gender, gender reassignment, sexual orientation or marriage, disability, race, religious belief or political opinion. They should not be disadvantaged by conditions or requirements which are not objectively justifiable or which can be accommodated through making reasonable adjustments where persons are disabled (as defined it the Disability Discrimination Act 1995) or which are not relevant to the job. Individuals will be recruited, promoted and treated in all other ways purely on the basis of merit and ability.
In order to demonstrate our commitment to this we are required to monitor the community backgrounds of employees and would ask that you complete the Equal Opportunities Monitoring Questionnaire. The information provided will be used only for preparing and submitting a monitoring return to the Equality Commission. In all other regards your answers will be treated with the strictest confidence and your identity will be kept anonymous.
You are not obliged to answer the questions on this form however determination may be made through use of the ‘residuary’ method if the questionnaire is not completed.
Gender □Male Marital Status □Married □Divorced
□Female □Single □Separated □Widowed
Community Background
□ Protestant □ Roman Catholic □ Neither Community
Ethnic Origin
□White □Bangladeshi □Chinese □Other
□Indian □Pakistani □Irish Traveller
□Black African □Black Caribbean □Mixed Ethnic
Disability: Disability Discrimination Act 1995
A person has a disability if s/he has a ‘physical or mental impairment which has a substantial or long-term adverse effect on his/her ability to carry out normal day to day activities.’
Do you meet (or have you in the past, met) this definition? □Yes □No
If yes, please tick the heading which best describes your disability:
□ Mobility □Vision □Hearing
□Speech □Mental □Learning □Dexterity/Co-ordination
Thank you for your co-operation in completing this questionnaire.