CD Fencing & Construction Services Ltd

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APPLICATION FORM
Name
Position applied for
Personal Details
Forename / Surname

Home Address

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Current Address (if different)

Post Code / National Insurance No
Telephone No – Home / Telephone No - Mobile
Email Address / Please tick if you would not like your payslip sent here. 
Education and qualifications – including work based (starting with the most recent first)

Dates

From and To:

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Institution

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Subjects taken and Qualification Gained

*Delete as appropriate

Employment Experience– use extra sheets if necessary.

Dates

From and To:

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Name and address of Employer and Nature of Business

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Job Role & Responsibilities

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Reason for Leaving

Training
Which relevant qualification cards do you hold?
i.e.
Lantra Traffic Management,
Lantra Vehicle Restraint Systems
FISS/CSCS,
Plant, First Aid, etc.
Personal Interests and Achievements (Use the space below to list any spare time activities)
Additional Information (Use the space below to provide any additional information that may strengthen your application
Other Information
When would you be available to start?
Are you prepared to work night shifts and weekends if required?
Are you prepared to work away from home, possibly on a regular basis?
Have you previously worked for CD Fencing (if so when?)
Do you have the right to work in the UK?
Do you require a work permit for this country?
Have you ever been dismissed from employment for drug or alcohol abuse?
CD Fencing operates a no tolerance policy to drugs and alcohol and applicants may be tested.
Are you a paid up member of a trade union? (if so, please give details)
Do you hold a current driving licence?
Do you have any other category of licence i.e. LGV, HGV etc?
Do you have a clean licence? If no, please give details?
Please give detail of any criminal convictions? (In accordance with the Rehabilitation of Offenders Act 1974)
Declaration
The information that you provide on this application is subject to verification. Falsification or misrepresentation may disqualify you from consideration for employment or, if hired, may be grounds for termination at a later date.
I declare to the best of my knowledge that the information given in this application is correct and I consent to it being held on file under the terms of the Data Protection Act 1998.
I acknowledge that if I am employed it is a condition for wages/salary to be paid directly into Bank/Building Society/Giro Accounts and that I may/will be required to undergo a medical examination.
Applicant Signature :......
Please complete the separate monitoring form attached.

MANY THANKS

PLEASE RETURN TO:-

CD FENCING & CONSTRUCTION SERVICES LTD

COCKLEBURY ROAD

CHIPPENHAM

WILTSHIRE

SN15 3QE

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EQUALITY AND DIVERSITY MONITORING

CD Fencing strives to operate a policy of diversity and equal opportunities in all aspects of our work.

The personal information requested in this form will help us to comply with the law and to ensure that our policies and practices are fair and effective. The information you provide is treated in the strictest confidence and will be processed in accordance with the Data Protection Act 1998.

If you would prefer not to answer any individual questions then please leave them blank. The responses that you give will assist us greatly in our commitment to diversity.

Gender

I would identify myself as:Male Female

Marital Status

Single Married/Civil PartnershipDivorced

Widowed Common Law Partnership Other

Age

Date of birth:

D D M M Y Y Y Y

Ethnicity

Asian or Asian British – Indian Mixed – White and Black Caribbean

Asian or Asian British – Pakistani Mixed – White and Black African

Asian or Asian British – Bangladeshi Mixed – White and Asian

Asian or Asian British – Other Mixed – Other

Black or Black British – Caribbean White – British

Black or Black British – African White – Irish

Black or Black British – Other White – Other

Chinese Other (please specify) ______

Disability

Section 1 of the Disability Discrimination Act 1995 describes a disabled person as a person with a ‘physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities’.

Using this definition, would you consider yourself to be disabled? Yes No

Nature of disability (please tick all that apply):

Deaf or hearing impaired Learning disabilities (includes dyslexia)

Blind or visually impaired Long-term illness or debilitating disease

Musco-skeletal (co-ordination/dexterity/mobility) other - please specify

Mental health (including serious depression) ______

If yes, do you require any special arrangements to be made to assist you if you are called for an interview?

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AF Issue 003Issue Date: May 10Page 1 of 5