Confidential Registration for Recruitment SW Ltd

Surname: / Name:
Address:
Home tel. no: / Mobile tel. no:
Date of Birth and Age / Area Preferred
Own Transport: Yes/No / Type of transport: Car Motorcycle Other
Physically fit : Yes/ No / Height:
Smoke Yes/No / Nationality:
Any criminal convictions : Yes /No / If yes, please specify
Any driving endorsements: Yes/No / If yes, please specify
Can start work from: / Married/ Single / No of children
Are you prepared to work: / Shifts Yes/No / Nights Yes/No / Weekends Yes/No

Please Circle Industrial Work Experience and Skills below

Driving
LGV
HGV1
HGV2
PSV
Multi-drop
Dumper
Forklift-counter
Balance-reach / Industrial
Lights unskilled
Heavy unskilled
Machine op
Production line
Operative
Warehouse
Picking
Packing
Food production
Supervision / Engineering
Machine operator
Electronic
CAD
CNC operator
CNC programmer
Grinding
Milling
Fanuc control
Electrical engineer
Mechanical engineer / Mechanical
Welding
MIG
TIG
Coded
Pipefitting
Sheet metal
Fitting
Fabricating
Mechanic / Building
Brick laying
Carpentry
Ground worker
Labourer
Crane licence
Surveyor / Have safety equipment
Boots
Hat
Overall

Please circle commercial work experience and skills bellow

Computer
Word
Excel
PowerPoint
Lotus 123
Access
Clait
Email
Internet / Office
Reception
Secretarial
Switchboard
Filling
Administration
Telesales / Accounts
Bookkeeping
Purchase ledger
Invoicing
Payroll
Computerised sys
Sage / Sales
Shop assistant
Management
Field sales
Door to door / Care
Child minding
Care worker / Hospitality
Chef
Bar
Waitress
Catering manager
Basic food hygiene Yes/No / Manual handling Yes/No / First Aid Yes/No

Aims &Objectives

What are you looking for? What are you prepared for? Please circle those that describe your needs the most

Permanent/Temporary / Managerial/Technical/ Care/Engineering/Factory /Quality assurance/Finance/Logistics/Sales/IT/factory work/work with food/outdoors/in an office/in a warehouse/other:
Full time/Part time
Holiday job
Please describe in your own words what are you looking for?

This information is accurate and I authorize ASAP ltd to take up references in connection with this application for employment

Signed:______ / Date:______
Last three Training establishments(Schools & Colleges)
Establishment / Dates from-to / Course / Outcome
Please supply names and addresses of two referees
1.
2.
Education and Training to date(tick and specify as appropriate)
GCSE / O level / A level / Degree
HNC / HND / Apprenticeship / Other

Previous employment

Name and address: / From To / Hours / Reason for Leaving
Duties:
Name and address: / From To / Hours / Reason for Leaving
Duties:
Name and address: / From To / Hours / Reason for Leaving
Duties:

Confidential Medical, Health and Safety Declaration

In the last two years have you missed work through illness or injury / Yes/No
If yes, how many days did you have off
Have you made a full recovery from your illness or injury / Yes/ No
If no, please provide certificate from a doctor stating that you are fit to return to work
Are you currently having medication or treatment prescribed by doctor / Yes/No
If yes, will you need to take the drug treatment during your working hours / Yes/No
Have you recently returned from overseas travel / Yes/No
Which country(ies) did you visit
If yes, did you suffer any illnesses while abroad / Yes/No

Do you or have you suffered from

Typhoid fever / Yes/No
Do you suffer from any allergies / Yes/No
If yes, then mention reason
Are you allergy to histamines / Yes/No
Salmonella / Yes/No

Currently are you or any of your household suffering from:

A nasal infection / Yes/No
A cough phlegm/sore throat / Yes/No
A discharging ear / Yes/No
Acne/boils/cold sores/sties/burns or septic fingers / Yes/No
Diarrhoea, abdominal pain or fever / Yes/No
Jaundice / Yes/No
Any skin trouble affecting the hand/arm or face / Yes/No
Do you consider yourself to be disabled, if so please supply reg. no / Yes/No

“

Personal Health Declaration:

I declare that all the foregoing statements are true to the best of knowledge. Should the situation change whilst:

A.  I am engaged on temporary assignment by ASAP in between assignments

B.  In between assignments of ASAP

I will immediately notify ASAP and if appropriate company, where I am working.

Signed:______Dated:______

Health and safety declaration:

I declare that while working in ASAP I will not use machinery or equipment unless I am experienced or have been instructed in its safe operation. I will at all times endeavour to work in a manner that avoids risk or injury to me and others.

Signed:______Dated:______

Please give the names and addresses of your next of kin in case of emergency:


______

______

Personal Details

Surname / Name
Address:
Telephone / Home / Mobile
Date of birth: / Sex: Male/Female
Marital Status: Married/Single
National insurance number:
Transport Car Motorbike Bike None
Next of Kin: / Telephone no:

Bank Details

I hereby authorize my wages to be paid into the following bank account Yes/No

Please pa my wages by cheque or cash ( a £5 will be charged for this) Yes/No

Name of bank/Building society
Address:
Account holders name
Account number
Sort code
Building society reference number
Signed

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3 Church Passage, Bridgwater, Somerset

Tel:01278422600 Fax: 01278423312