CONFIDENTIAL

MUNSTER SIMMS ENGINEERING LIMITED

A P P L I C A T I O N F O R E M P L O Y M E N T

(Please print clearly using block capitals)

POSITION APPLIED FOR: JOB REF NO:

How did you hear of this vacancy?

PERSONAL

Title First Name(s) Surname

Address and postcode

Home Telephone No: Mobile:

Email address:

N.I. Number

Yes/No

Do you hold a current driving licence?

Yes/No

Is it clean?

EDUCATION

Give details of all secondary, further and higher education, beginning with the most recent.

Type of Institution / Subject(s) / Grades/Qualifications

Details of other courses/qualifications

PERSONAL STATEMENT

In your opinion, what skills, qualifications or experience do you have which would especially suit you for the job you are applying for? (If necessary continue on a separate sheet of paper and attach to the back of the application form.

EMPLOYMENT HISTORY

Beginning with your most recent employer, list details of your employment history; include any periods of unemployment and continue on an additional sheet if necessary.

Name and Address of Employer / Dates of Employment / Job Title and Duties / Reasons for leaving / Pay/Salary

May the company contact any of the above employers? Yes/No

List which one(s) you do not wish to be contacted.

REFERENCES

Please give the names of two people (not relatives) who may be contacted for a reference, one of which must be a previous employer.

Name:Occupation:

Address

Postcode:Telephone number:

Name:Occupation:

Address

Postcode:Telephone number:

Are you currently employed? If Yes, what notice is required?

Yes/No

NOTE: The successful applicant will be required to complete a medical questionnaire. The Company reserves the right to require a successful applicant to undergo a medical examination by a doctor appointed by the Company.

I HEREBY DECLARE THAT ALL THE INFORMATION GIVEN IN THIS APPLICATION IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE, AND I REALISE THAT ANY WILFUL MIS-STATEMENT COULD RENDER ME LIABLE TO DISMISSAL IF ENGAGED

SIGNED : DATED:

PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION FORM AND RETURN IT BY THE SPECIFIED DATE TO:

THE MONITORING OFFICER

MUNSTER SIMMS ENGINEERING LIMITED

2 ENTERPRISE ROAD

BANGOR BT19 7TA

MUNSTER SIMMS ENGINEERING LIMITED

MONITORING FORM

MONITORING

REF NO:

Munster Simms is a fair employer committed to providing equal opportunities to all candidates regardless of religious affiliation, religious belief, political belief, sex, race, marital status, age, sexual orientation, disability or part time or full time status.

In order to demonstrate our commitment to equality of opportunity and meet our obligations under Fair Employment legislation we are required by law to monitor the religious affiliation and sex of all job applicants.

The information you are asked to supply below will be treated in the strictest confidence and protected from misuse. This information will not be available to anyone making decisions about your application and will be used for monitoring purposes only and for the purpose of recruiting for the post applied for. The information will be stored for 4 years.

The information provided on the form will be removed by our Monitoring Officer prior to consideration of your Application:

1.Please indicated your Religious Affiliation by placing an ‘X’ in the appropriate box below:

I am Protestant

I am Roman Catholic

Other (Please specify)

2. Please indicate whether you are male or female by placing an ‘X’ in the appropriate box

I am male

I am female

3. Date of Birth

4. Do you have any disabilities? Yes/No Are you registered disabled? Yes/No

Are there any special provisions that you will need in order to attend an interview? Yes/No

If yes please give details

This form must be completed and returned with the application form, otherwise your application may not be considered. Thank you for your co-operation.