ConfidentialPage 111/28/2018

Please use BLOCK CAPITALS – Incorrect information may jeopardise your employment.

PERSONAL DETAILS
Title: / Surname: / Forenames:
Date of birth: / (Required for manpower planning and retirement procedures)
National Insurance No: / E-mail:
Home address:
Postcode:
Home telephone number: / Mobile telephone number:
If you wish to do so, please give details of next of kin or person who can be contacted in an emergency.
Name: / Relationship:
Address: / Home telephone: / Work telephone:
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EMPLOYMENT REQUIRED
1.1 / Position Applied for:
1.2 / Expected Pay:
1.3 / Availability:
1.4 / Have you previously worked for us?
If Yes, please give details: / Yes  / No 
1.5 / Do you have any relatives working for us?
If Yes, please give details: / Yes  / No 
1.6 / Why are you applying for this position?
1.7 / Method of commuting to your place of work?
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EDUCATION, QUALIFICATIONS & SKILLS
2.1 / Comprehensive
School name / address / Dates / Qualifications
(courses / subjects / results etc)
From / To
2.2 / Further education and training
University / College / Dates / Qualifications
(courses / subjects / results etc)
From / To
2.3 / Occupational qualifications
College / Institute or other name / Dates / Qualification / level
From / To
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/
DISABILITIES
Do you require any special arrangements to be made for your interview / assessment on account of a disability?
Should there be a need please give details and thus aiding us to meet our obligations under the Equality Act 2010
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/ Please give details of 2 previous employers we could approach for references:
Name: / Occupation:
Address:
Telephone No:
Name: / Occupation:
Address:
Telephone No:
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.
Signature: Date:

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EMPLOYMENT HISTORY
Previous employment
Please give details of your previous employment starting with the current / most recent
5.1 / Employer:
Type of business:
Address:
Position held: / From: / To:
Type of work and responsibilities:
Reason for leaving:
5.2 / Employer:
Type of business:
Address:
Position held: / From: / To:
Type of work and responsibilities:
Reason for leaving:
5.3 / Employer:
Type of business:
Address:
Position held: / From: / To:
Type of work and responsibilities:
Reason for leaving:
5.4 / Employer:
Type of business:
Address:
Position held: / From: / To:
Type of work and responsibilities:
Reason for leaving:
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GENERAL
6.1 / Interests / hobbies:
6.2 / Offices held in social / sports clubs:
6.3 / Public duties undertaken (JP, local councilor etc):
6.4 / Have you ever been convicted of a criminal offence?
(Declaration subject to the Rehabilitation of Offenders Act) / Yes  / No 
6.5 / Membership of professional organisation:
6.6 / If offered this position will you continue to work in any other capacity? (If Yes please give details) / Yes  / No 
6.7 / Community / volunteer experience: / Date from: / To:
Name and address of organisation:
Position / title:
Duties:
7 /
ELIGIBILITY FOR EMPLOYMENT IN THE UK
In order to comply with the Immigration Act 1996, we are required to see proof of your right to work in the UK.
If you are offered an interview, you will be asked to provide an original copy of one or a combination of the documents contained within the attached pre employment document list. Failure to supply the correct documentation may result in an offer being delayed or withdrawn.
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AUTHORISATION & DECLARATION

Data Protection Act

Information from this application may be processed for the purpose registered by the Employer under the data protection Act 1998. Individuals have, on written request the right of access to the personal data held about them and on payment of a fee a copy of such personal data held about them.
All unsuccessful applications will be disposed of after 3 months of the date of application.
I hereby give consent to (Harrier Llc) processing the data supplied in this application form for the purpose of recruitment and selection.
Signature: Date:
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:

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