APPLICATION FORM

Central Laundry. Nicolson Way, Burton upon Trent, DE14 2AW

Today’s Date………………………………………..

First Name………………………………..Surname……………………………….

Address……………………………………………………………………Post Code ………

Telephone Number………………………… Mobile Number……………………………….

Gender Male/Female National Insurance Number ….………………………………..……..

Date of Birth……………… Age……. Are you legally entitled to work in the UK Yes/No

Which position are you applying for? …………………. Do you hold a driving licence ……….

Please detail any endorsements ………….……. Do you have a criminal record Yes/No

If so provide details on a separate sheet.Registered Disabled Yes/No

Long Term Illness Yes/No (if yes please provide details on a separate sheet)

Any allergies or conditions e.g. Heart disease, asthma etc. Yes/No (If yes please provide details on a separate sheet).

EDUCATION

Name of School/College / Start Date / Leaving Date / Qualifications

HOBBIES AND INTERESTS

WORK EXPERIENCE

Employers Name and Address / From / To / Position Held / Detail Your Responsibilities and Reason for Leaving

Continued employment is subject to receipt of satisfactory references. Please detail below name, address and telephone number of two referees we may contact prior to your employment with our company.

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I certify that my answers are true and complete to the best of my knowledge.

I authorise you to make such investigations and inquiries of my personal, employment, educational and financial history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview may result in discharge.

Signature of Applicant………………………………Date……………………….

Under the Asylum and Immigration Act 1996 Central Laundry has a legal duty to check all new employees are legally entitled to work in the UK. Therefore Central Laundry must have sight of ONE of the following documents appertaining to yourself.

Passport or Work Permit or National Identity Card or Birth Certificate