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					                                      JOB APPLICATION FORM                                                  1




      Position Applied For:- _____________________________________________________________________

PERSONAL DETAILS


Full Name:-______________________________________________________________________________

Address:- ______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Contact Telephone Number/s____________________________________________________________

Are you legally eligible for employment in the UK (if you are unsure please seek advice from Company
Management:- __________________________________________________________________________


Do you have a current full driving licence?                          Yes           No

Driving licence valid from:-__________________ To:- __________________

Number of Penalty Points (if any) endorsed on current licence:- ______________________

Have you ever been disqualified from driving, or had motor insurance refused?           Yes        No

If “Yes”, please provide brief details_________________________________________________________

A copy of your driving licence must be provided upon offer of position and any changes to be reported
immediately. Please note a copy of your driving licence must be provided every 6 months along with a
copy of your current car insurance (if using your own car during to make calls to service users)




EDUCATION – please continue on a separate sheet if necessary.
From To      Name of University, College,       From To                  Name of University, College, Place of
             Place of Further Education i.e.                             Further Education i.e. training
             training establishment                                      establishment




Examination results/qualifications obtained please detail any qualifications/certificates you hold along with
the date obtained you feel may be relevant to the position applied for.
                                 JOB APPLICATION FORM                                                 2




EMPLOYMENT HISTORY
Name and Address of Current Employer (or last      Job Title and Main Duties       Employment Dates
Employer if currently unemployed)                                                  From     To




Reason for Wanting to Leave/Leaving:                Average gross pay: £
                                                    per hour/week/month
Previous Employment (Employer Name, Address and your Job Title and dates of employment)
for a Minimum of 10 years
please continue on a blank sheet if necessary, ensure any gaps in employment history are explained.
1.                                                                                 From          To




2.                                                                                 From         To




3.                                                                                 From         To




4.                                                                                 From         To




5.                                                                                 From         To




6.                                                                                 From         To
                                     JOB APPLICATION FORM                                                   3




7.                                                                                      From           To




8.                                                                                      From           To




9.                                                                                      From           To




Notes to explain gaps in employment history (please continue on a blank sheet if necessary):-
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________


JOB FLEXIBILITY
Prepared to Work:        Full-Time        Part-Time
Details of any other work which you will continue to undertake if you are offered this Job Position:

Please provide details of any outstanding holidays to be taken:


Available to take employment from:-


REHABILITATION OF OFFENDERS ACT, 1974
Through the 1975 exemptions Order of the Rehabilitation of Offenders Act, 1974, and by virtue of the nature
of the post for which you are applying, we are obliged, as your prospective employers, to ask the following
question. Any information supplied by yourself will remain confidential and considered only in relation to
the Job Application:

With the exception of minor motoring offences, have you ever been convicted of any criminal offence by
a Court of Law?

YES       NO
If “YES” please provide brief details of the offence(s) and relevant dates:
                                    JOB APPLICATION FORM                                                       4
 ………………………………………………………………………………………………………………………………………

 ………………………………………………………………………………………………………………………………………
 All positions are subject to a Criminal Records Bureau checks (Enhanced)



 EQUAL OPPORTUNITIES – VOLUNTARY INFORMATION

 The organisation seeks to recruit employees on the basis of their general suitability for a position and aims to
 ensure that consideration of age, sex, marital status, disability and racial or ethnic origin should play no part
 in this process.

 In order to monitor the effectiveness of this commitment to equal opportunities it would be helpful if you
 could complete this section of the form. Completion is not compulsory but should you give details below
 the information will be used for no other purpose than that as stated in this paragraph.

 Marital Status          Single    Married     Separated      Widowed       Divorced

 Sex                     Male      Female

 Ethnic Origin           African   Afro-Caribbean      Mixed Race       Asian     European




 References :-

 We will require at least two written references, from people you are not related to, one of which must be
 your current or most recent employer:-

 Reference One:-

 Name of Referee :-     ______________________________________

 Position:-             ______________________________________

 Company Name:-         ______________________________________

 Company Address:-      ______________________________________

                        ______________________________________

                        ______________________________________




References :-

Reference Two:-

Name of Referee :-     ______________________________________

Position:-               ______________________________________
  DECLARATION - please read carefully ensuring 10 year employment history is complete and any gaps
  explained in full, then sign and date your application:
Company Name:-           ______________________________________
I certify that to the best of my knowledge, the information in this application form is correct and complete.
I agree Address:- ______________________________________
Companythat any deliberate omissions, misrepresentations or falsification of the information in this

                       ______________________________________

                       ______________________________________
                                    JOB APPLICATION FORM                                                  5
application form will be grounds for the application to be rejected, or possibility of subsequent discharge
once employed by the Company. I understand that if employed by the Company this form may be filed
on computer and/or in manual records and will be made available to visiting inspectors as necessary.


Applicant’s signature:- _______________________________________

Date:-                 ________________________________________



  Office Use:-




                                                    Medical History

         Has your employment ever been
         terminated on the grounds of ill health?               YES                     NO
         Approximately how many days sickness
         have you had in the past 12 months?
         What is your height?
         What is your weight?
         What is your weekly alcohol
         consumption?
         Do you smoke?
         Are you currently taking any prescribed
         medicine?
         Are you currently under the care of a
         doctor or other medical professional?

         Are you currently suffering from of have suffered from, any of the illnesses listed:-
         Lung Disease                                          YES                      NO
         Heart/circulatory illness/hyperventilation            YES                      NO
         Diabetes                                              YES                      NO
         Asthma                                                YES                      NO
         Hayfever/allergies                                    YES                      NO
         Bronchitis/Pneumonia/Pleurisy                         YES                      NO
         Tuberculosis                                          YES                      NO
         Epilepsy/Frequent fainting/blackouts                  YES                      NO
                            JOB APPLICATION FORM                                                         6
 Headaches Migraines                                   YES                    NO
 Psychiatric illness/anxiety/depression                YES                    NO
 Dermatitis/skin sensitivity                           YES                    NO
 Back/neck problems                                    YES                    NO
 Recurrent Infections                                  YES                    NO
 Hepatitis/jaundice                                    YES                    NO
 Stomach/bowel trouble                                 YES                    NO
 Joint problems                                        YES                    NO
 Severe stress reaction                                YES                    NO
 Depression/anxiety                                    YES                    NO
 High blood pressure                                   YES                    NO
 Hernia or rupture                                     YES                    NO
 Kidney/bladder problems                               YES                    NO
 Hearing/sight problems                                YES                    NO
 Mobility problems                                     YES                    NO
 Serious accident                                      YES                    NO

If you have answered “YES” to any questions in this section, please give details and dates where
relevant; this is important, especially where you have a qualifying disability under the Disability
Discrimination Act 1995, as it will enable us to identify what, if any “reasonable adjustments”
need/can be made.




I hereby declare that the information given within the medical history section is full and true to the
best of my knowledge. I understand that if, later, it is discovered that I have knowingly withheld
medical information, disciplinary action may be taken against me, which may include dismissal.

Signature: ____________________________________________

Date:     ____________________________________________

				
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Description: Aside from Personal Profile, a good job application form which requires transparency from a job candidate must contain details of and be divided into similar parts as these: 1) Qualifications and Certificates - in a great sense this will list the intellectual capacity and training the aspirant has. Noted will be the score he/she got in screening examinations [if need be], trainings attended and completed and certificates of merit that may be relevant to the job-in-offer. 2.) Employment History of the Applicant - in this part must be entered at least a ten-year history of the former jobs the applicant has held. Gaps in the working years must have to be explained and the reasons of leaving the former posts/jobs will have to be stated. Also, this will tell if the applicant is currently employed but has the intention to leave the job or is already scheduled to resign from his/her current post. 3.) Job Flexibility - the applicant must present how he/she is flexible to the demand of the job concerning Full-time/Part-time status of post offered, capability to do multi-tasking, personal stand on Holidays, and the immediacy of time of being able to work when offered the position. 4.) Criminal History - this will test the honesty of the applicant whose information disclosed can be verified from the proper sources. 5.) Medical History - this will clearly indicate if the applicant is physically suitable to the position offered, or might move the hiring company to employ suited adjustments. A checklist of the common medical issues will ease the task.