Application Form

PLEASE COMPLETE THIS FORM AND RETURN TO:

Human Resources

Frans House

Fenton Way

Chatteris, Cambridgeshire

PE16 6UP or email to

NB You are welcome to supplement this form with your C.V., if you have one.

POSITION APPLYING FOR
Personal Details
Surname / Title
Forename / NI Number
Home Address / Postcode
Telephone / day / evening / mobile
When are you available for interview?
Do you have any special requirements in relation to your interview arrangements?
Is your ability to perform the job for which you are applying limited in any way?

(If you have answered YES to either of the above questions, tell us about any adjustments we may need to make to assist you)
Do you have the right to work in the UK?
Do you require a work permit to work in the UK?
Current or Most Recent Job
Company Name
Company Address
Your job title
Main duties
Pay rate / Hours of work
Start Date / Leave Date
Reason for leaving?
Previous Employment (or work experience if recent school leaver)
Company Name
Company Address
Your job title
Main duties
Pay rate / Hours of work
Start Date / Leave Date
Reason for leaving?
Company Name
Company Address
Your job title
Main duties
Pay rate / Hours of work
Start Date / Leave Date
Reason for leaving?
Education/Qualifications/Job Training
List all school, college or university qualifications you have and where you gained them.
REFERENCES
Please give below details of people who are willing to give you a reference and tick when to contact
Name and position / Contact address
(if known) / Telephone No. / Years known / Tick when referee can be contacted


Other Information
Please tell us why you are interested in the post and provide any other information that may assist your application.
DECLARATION – THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS
I confirm that the information on this form and any other material submitted by me is true and accurate to the best of my knowledge. I accept that any false or misleading information could result in m y dismissal.
I confirm that this form has been completed by me in person.
Signed………………………………………………………………………… Date
Candidates who are unable to complete the form themselves because of a disability should ask the person assisting them to sign the declaration below on their behalf.
I confirm that I have completed this form on behalf of (Candidate’s name) entering only those details given to me by the candidate. The candidate understands that any false or mistaken information could result in his\her dismissal.
Signed………………………………………………………………………… Date
Your Name
*Please also state your capacity on behalf of the candidate (e.g. parent, spouse, other relative, friend etc.)

Document: Combined Application & Equal Opportunities Monitoring form

Issue Number: v1.0

Issue Date: January 2015