|
|
Telephone No. 01234 376274 e-mail theplough@bolnhurst.com website www.bolnhurst.com |
Position applied for:
Personal Details
Surname_________________________________________________________
Forenames_______________________________________________________
Address__________________________________________________________
________________________________________________________________
Telephone (home)_____________________Mobile_______________________
E-mail ______________________________
Name & Address of next of kin________________________________________
________________________________________________________________
________________________________________________________________
Current or Most Recent Job
Job Title_________________________________________________________
Employer’s Name & Address_________________________________________
________________________________________________________________
________________________________________________________________
Date started ____________ Leaving date________________ Salary_________
Brief outline of duties_______________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Notice required____________________________________________________
Reasons for wishing to leave:_________________________________________
________________________________________________________________
Previous Employment
Job title & duties:
_________________________________________________________________
_________________________________________________________________
Employer’s name and address
________________________________________________________________
_________________________________________________________________
Length of employment from to
Reason for leaving ___________________________________________________
__________________________________________________________________
Job title & duties:
__________________________________________________________________
__________________________________________________________________
____________________________________________________________
Employer’s name and address
___________________________________________________________________
___________________________________________________________________
Length of employment from to
Reason for leaving _____________________________________________________
____________________________________________________________________
Education & Training
Please list all secondary education and any further education or training
|
School / College / University |
Dates attended |
Qualifications gained |
|
|
|
|
General
Are you prepared to work more than 38 hours a week if requested to do so ? Yes / No
Do you possess a valid current driving licence ? Yes / No
Do you have the use of a car to travel to work ? Yes / No
Do you require staff accommodation (full time only) Yes / No
Do you require a work permit ? Yes / No
Please provide your National Insurance No ___/___/___/___/___
Please give details of any criminal convictions you may have had, excluding any “spent”
under the Rehabilitation of Offenders Act 1974.
Health Record
Please state how many days you have absent from work /college due to illness during the last 2 years:______________________________________________
________________________________________________________________
Long term health – do you have any health problems that we should be aware of ?
_______________________________________________________________
_______________________________________________________________________
Supporting Statement
Please state why you want this particular post; highlighting the skills and experience that you could contribute to our company:__________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
References
Please give the names and addresses of two referees; the first of whom should be your current (or most recent) employer. Any offer of employment made will be subject to the receipt of satisfactory written references.
Please indicate if we may take up references at this stage Yes / No
Name _____________________________________________________
Address _____________________________________________________
_____________________________________________________
Position ______________________________ Tel. No ________________
Name _____________________________________________________
Address _____________________________________________________
_____________________________________________________
Position _______________________________Tel. No ________________
In what capacity do you know your second referee ? _____________________
_______________________________________________________________
Declaration
I declare that the information I have given on this form is correct and I understand that misleading statements may be sufficient grounds for cancellation of any agreement / contract of employment.
Signed: _________________________ Date: ________________________
Please send your completed form to Michael Moscrop at the address above.