Ecurity (N.I.) Limited

Ecurity (N.I.) Limited

S

/ WORD
ECURITY (N.I.) LIMITED
68 Donegall Pass
Belfast, BT7 1BU
Tel: 02890 503040 Fax: 02890 503041

APPLICATION FOR EMPLOYMENT

Start date: _____/_____/_____Termination date:_____/_____/_____

Please answer ALL questions, using BLOCK CAPITALS.

If an entry is inapplicable insert “NO” or “N/A”. Please circle appropriate answer. Please use a black pen.

1. PERSONAL INFORMATION

Mr/Mrs/Miss/Ms Forenames:______

Surname:______Aliases:______

Current Address: ______

Postcode:______How long have you lived at this address? ______

Please detail addresses lived in the last 5 years:

______

Tel. No: Home______(Mobile)______

Email Address:______

If not born in the UK state where:______Willing to relocate? YES / NO

Are there any restrictions on you taking employment in the UK? YES / NO

Please give details on these restrictions: ______

Name and address of next of kin: ______

______Relationship: ______Tel. No: ______

Do you require full time or part time work? ______

2. BACKGROUND INFORMATION

National Insurance Number: / If no NI number, supply proof of having applied to the DSS

HAVE YOU EVER BEEN CONVICTED OF ANY OFFENCE OR HAVE BEEN CAUTIONED BY THE POLICE? YES / NO (If yes, please give details below)

HAVE YOU ANY PROSECUTIONS PENDING? YES / NO (If yes, please give details below)

DATE OF CONVICTION OR CAUTION / OFFENCE / SENTENCE

Do you have any outstanding judgements for debt, or have any financial judgements in the civil court in the last 6 years (this includes bankruptcy proceedings, court judgements and IVAs)

YES / NO (If yes, please give details,a credit check will be carried out)______

______

Do you hold a current SIA Licence? YES / NO (If yes state type, number and expiry date, this will be checked on the public register prior to commencement of employment)______

______

3. DRIVING LICENCE

Do you hold a U.K. driving licence? YES / NO Full / Provisional

Licence Number: ______

Do you own your own transport? YES / NO

Do you have any motoring offences? YES / NO (If yes, please give details of offence and date of conviction) ______

4. FIRST AID

Do you hold a current First Aid Certificate under the Health & Safety at Work Act? YES / NO

If yes - date of expiry:______

5. PHYSICAL RECORD (delete where applicable)

Do you have a physical or mental impairment which has a substantial and long-term effect on your ability to carry out day-to-day activities? YES / NO

If yes, please specify any special arrangements you require for work associated with any impairments
______

Please specify any special arrangements you will need to attend any interview at our offices

______Please list any diseases, disorders, allergies, muscular or musculoskeletal injuries from which you suffer or have suffered

______

Please detail all forms of medicine, drugs or treatment you are currently / regularly receiving

______

Please list all absences from your previous employment in the last twelve months and the reasons for these absences

______

6. EDUCATION

Name and addresses of Schools, Polytechnics, College and University attended / From / To / Exams Passed

Are you a Student at present? YES / NOFull Time / Part Time

7. SERVICE RECORD (Circle where appropriate)

Royal Navy / Army / RAF / Police / Fire Service / Merchant Navy Date: From ______to ______

If service in the Army, state Regiment or Corps: ______

If service in the Police / Fire Brigade, state name of Force or Brigade:______

Rank attained: ______Decorations: ______

Are you liable to recall? YES / NOConduct Record: ______

Reason for leaving: ______

Are you a member of any RESERVE involving annual training? YES / NO ______

8. EMPLOYMENT / UMEMPLOYMENT RECORD

Please list ALL periods of employment and unemployment,including gaps for travel covering the last 5 years and give reasons for any time lapse between employment periods.If you have a gap for travel that exceeds 31 days then proof of whereabouts will be required (for example plane tickets, passport stamps etc)

If your previous employer closed down we need evidence such as P60, offer and redundancy letters etc

DATE
(Give month and year) / NAME & ADDRESS OF EMPLOYER(S) / JOB
TITLE / SALARY / REASON FOR LEAVING
FROM / TO
1. / Company Name:
Building No:
Street:
Postcode:
Contact Name:
Tel No:
Email Address:
2. / Company Name:
Building No:
Street:
Postcode:
Contact Name:
Tel No:
Email Address:
3. / Company Name:
Building No:
Street:
Postcode:
Contact Name:
Tel No:
Email Address:
4. / Company Name:
Building No:
Street:
Postcode:
Contact Name:
Tel No:
Email Address:

Please continue on a separate sheet if necessary

9. PERSONAL REFERENCES

Please give the name, address and occupation of two persons who areNOT PREVIOUS EMPLOYERS, RELATIVES ( BY BLOOD OR MARRIAGE) OR WHO RESIDE AT THE SAME ADDRESS AS YOU.

AT LEAST ONE REFERENCE MUST BE KNOWN TO YOU FOR A MINUMUM OF TWO YEARS IMMEDIATELY PRIOR TO APPLYING

1.Name: ______2. Name: ______

Address: ______Address: ______

______

______

Postcode: ______Postcode: ______

Tel. No.: ______Tel. No.: ______

Relationship: ______Relationship: ______

How long known: ______How long known: ______

10. BUSINESS & TRADE REFERENCES

If you have been self employed, give the name address of two persons, other than the personal references above, who can confirm this e.g. Solicitor, Accountant, companies with whom you traded.

1.Name: ______2. Name: ______

Address: ______Address: ______

______

______

Postcode: ______Postcode: ______

Tel. No.: ______Tel. No.: ______

Occupation: ______Occupation: ______

How long known: ______How long known: ______

11. DECLARATION

I understand that my employment is subject to satisfactory screening. I authorise Sword Security (N.I.) Limited to carry out all such enquires, as may be necessary at the company’s discretion, into my background and employment record. * (Personal Reference and Verification Form)

I hereby declare that the information I have provided on this Application Form is current and truthful and that any false statementsor omissions,I have made shall be considered cause for dismissal.

I hereby certify that I have filled in this Application Form myself and that I have read, understood and agree to abide by this declaration.

May we approach your present employer? YES/NO.

Signature of Applicant: ______Date: ______

POSITION APPLIED FOR______LOCATION______

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