EMPLOYMENT APPLICATION FORM

POSITION APPLIED FOR ………………………………………………

Mr/Mrs/Miss/other: ……………………………………(delete as applicable)

Forename(s): ………………………………………………………………….

Surname: ………………………………………………………………………

Current Address: …………………………………………………………….

………………………………………………………………………………..

…………………………………Post Code…………………………………..

Telephone Number: ………………………………………………………….

If you have lived here less than 5 years please give previous address(s)includingdates of moving (this can be continued on a separate piece of paper if required) ………………………………………………………………………………..

………………………………………………………………………………..

………………………………....Post Code…………………………………..

Full Name at Birth if different from above …………………………………

………………………………………………………………………………..

Date of Birth: ………………………………………………………………..

Town of Birth: .……………………………………………………………..

Nationality: ...………………………………………………………………..

Mother’s Family Name: ……………………………………………………..

National Insurance Number:…………………………………………………

Please note this information may be used to obtain a basic disclosure from the Criminal Records Bureau.

Education/Training

Further Education details and examinations : / Courses and Results
Continue on separate sheet
Examinations since leaving full time education: / Examinations and Results
Continue on separate sheet
Any other exams/training that may be relevant to this application / Diploma/Qualification
Continue on separate sheet

Employment Details

Please give details of your past employment, stating the most recent first

Name and address of employer / Dates / Position held/Main duties / Reason for leaving
Continue on separate sheet

Do you have any secondary employment? Yes/No

(part-time, evenings etc)

If yes please give details: ………………………………………………….

………………………………………………………………………………

……………………………………………………………………………….

Other:

Do you have any criminal convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974?)

Yes/No

If yes please give details: ……………………………………………………

…………………………………………………………………......

Do you hold a full driving licence? Yes/No

If yes do you have any driving convictions? Yes/No

If yes please give details: …………………………………………………….

………………………………………………………………………………..

Do you own your own car? Yes/No

Do you hold any other driving licence? Yes/No

(HGV, Motorcycle etc)

If yes please give details: …………………………………………………….

Any other relevant experience? (towing/computer use etc)

………………………………………………………………………………

………………………………………………………………………………

If offered employment, you will be required to complete a Medical Questionnaire. Are you prepared to undergo a medical examination before starting employment? Yes/No

Have you ever worked for the Sanctuary before?Yes No

Do you have any phobias? Yes/No

(spiders, rats, needles, heights, blood etc)

If yes please give details: …………………………………………………….

………………………………………………………………………………...

What is your long term ambition?

……………………………………………………………………………….

References

Please give the name of two people (one of which should be your present or most recent employer) whom we may approach for a reference.

Can we approach your current employer before an offer of employment is made? Yes/No

NameName

PositionPosition

AddressAddress

Telephone NumberTelephone Number

How did you hear of this vacancy? ………………………………………………………...

I confirm that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal. I understand these details will be held in confidence by the Sanctuary, for the purpose of ongoing personnel administration and payroll administration in compliance with the Data Protection Act 1998. I undertake to notify the Sanctuary immediately of any changes to the above details.

Signed……………………………………………………Date....……………