Document Sample
					Office Concierge Application Form

                                OFFICE CONCIERGE COMPANY LTD

                                       STANDARD APPLICATION FORM
                                        28 Wimpole Street London WIG 8GW
                                       T: 020 7636 2829      F: 020 7323 0698

                         How did you hear about this vacancy?
                        Evening Standard                 Metro              TUPE Transfer             Other

                           London Jobs                   Reed                Office Recruit

                         Referred by:

Please provide us with a passport size photo
Please answer all the questions fully, using block capitals

Personal Details
Surname                                                     First Name
Mr / Mrs / Ms / Miss / Dr / other (specify)                                              Gender         M/F
Permanent Home Address                                      Date of Birth
                                                            Country of Birth
                                                            National Insurance No.
                                                            Marital Status
                            Postcode                        Ages of Children
Contact Details
Telephone - Mobile
Telephone - Home
Telephone - Work
Personal Email

Nationality / Visa Details
Citizenship / Nationality                                    Country of Issue
Passport No.                                                 Status (i.e. Native / Dual)
Issue Date                          Exp. Date                Issuing Country
Nationality details
Do you require a work permit to work in this country?                                      Yes / No
If yes, do you currently hold a work permit                                                Yes / No
If you have answered yes to any of the above, please complete the following;
Country                                   Type Status (e.g. applied/renewed)
Number                                    Duration                                   Start date
Expiry date                               Issuing Country

Do you have any relations working within OC?                 Yes / No

Office Concierge Application Form

Emergency Contact Details
Surname                                              Forenames
Relationship                                         Address
Telephone (work)
Telephone (mob)                                      Postcode
Email Address

Qualifications and Languages
Do you hold a current First Aid Certificate       Yes        No       Expiry Date
Languages                                          Fluent             Intermediate           Basic

Date From                                     Date To
Address                                       Courses and results

Further Education College
Date From                                     Date To
Address                                       Courses and results

Secondary Education
Date From                                     Date To
Address                                       Courses and results

Employment History and References
We would like employment details going back 10 years (if applicable). If you require more space,
please use a second page and then reverse.
Current / Last Employer
Date from                                            Date to
Company Name
Address                                                                              Post code

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                                    Title
Telephone No.                                        Email
Number of days sickness absence in last 12 months                 (    ) days

Office Concierge Application Form

Previous Employment
Date from                           Date to
Company Name
Address                                       Postcode

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                   Title
Telephone No.                       Email:

Previous Employment
Date from                           Date to
Company Name
Address                                       Postcode

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                   Title
Telephone No.                       Email:

Previous Employment
Date from                           Date to
Company Name
Address                                       Postcode

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                   Title
Telephone No.                       Email:

Previous Employment
Date from                           Date to
Company Name
Address                                       Postcode

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                   Title
Telephone No.                       Email:

Office Concierge Application Form

Previous Employment
Date from                                             Date to
Company Name
Address                                                                  Postcode

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                                     Title
Telephone No.                                         Email:

Previous Employment
Date from                                             Date to
Company Name
Address                                                                  Postcode

Job Title
Salary on leaving
Reason for leaving
HR / Contact Name                                     Title
Telephone No.                                         Email:

Personal Referees
Please give details of two people (not relatives or last employer)
Name                                                 Name

Address                                              Address

Postcode                                             Postcode
Phone number                                         Phone number
Home No                                              Home No
Work No/Mob. No                                      Work No/Mob. No
Email                                                Email
Occupation                                           Occupation

Criminal Convictions
Have you ever sustained any criminal convictions, no matter how petty?
Please state “Yes” or “No”
If “Yes”, please give details:

Office Concierge Application Form

Equal Opportunities

Office Concierge will take all reasonable steps to employ, train and promote employees on the
basis of their experience, abilities and qualifications without regard to race, colour, ethnic origin,
nationality, national origin, religion or belief, sex, sexual orientation, marital status, age or
disability. Office Concierge will also take all reasonable steps to provide a work environment in
which all employees are treated with respect and dignity and that is free of harassment. Office
Concierge will not condone any form of harassment, whether engaged in by employees or by
outside third parties who do business with Office Concierge.

Ethnic Background
Black                               Caribbean                       British
                                    African                         Other (please specify)

White                               English                         Welsh
                                    Scottish                        Irish
                                    British                         Other (please specify)

Mixed                               White & Black Carribean         White & Black British
                                    White & Black African           White & Asian
                                    Other (please specify)
Asian                               Indian                          Bangladeshi
                                    Pakistani                       British
                                    Other (please specify)
Chinese                                                             Other ethnic group
                                                                    (Please specify)
Prefer not to say

Christian                           Sikh                                 Buddhist
Catholic                            Muslim                               Rastafarian
Jewish                              Hindu                                None
Other (please specify)                                                   Prefer not to say

Please state any disabilities you may have by ticking below: -
Physical Disability                                  None
Mental Disability                                    Prefer not to say

Office Concierge Application Form


I certify that the information contained on this form and any attachments is complete and accurate in all
respects. I hereby authorise Office Concierge Company Limited or its agents to conduct reference checks
on my employment, verify the information I have provided, conduct comprehensive background
investigations and take up my personal references.

I understand that all offers of employment are conditional upon references satisfactory to the Company
and proof of permission to undertake work in the UK. I understand that any information obtained that may
have precluded Office Concierge Company Limited from making me an offer of employment may lead to
withdrawal of the offer. If discovered after my employment has commenced, I understand that this may
lead to disciplinary action including dismissal.

I permit Office Concierge Company Limited to record and store the information contained in this form, and
any other information as part of the pre-employment formalities, in any safe and secure format necessary
to facilitate its use. I understand that the information may be passed to regulatory bodies, Government
Agencies, and other third parties as required by law or for company administration purposes.

Name                                                                          Date


Applicant Waiver

                           (All job applicants must sign and submit with application form)

To: ___________________________________________________________________

I hereby certify that the information contained in the attached application form is correct to the best of my
knowledge and belief. I understand that falsification of this information is grounds for your refusing to
engage or employ me or, if employed, instant dismissal, without notice or pay in lieu.

I hereby authorise any of the persons or organisations listed in my application to give all information
concerning my previous employment, education, or any other information they might, have, personal or
otherwise, with regard to any of the subjects covered by this application, and I hereby release all such
parties from all and any liability that may result from providing such information to you. I authorise you to
request and receive such information.

I understand that no representative of the company has any authority to enter into any agreement for
employment for any specified period of time, or assure or make some other personnel move, either prior to
commencement of employment or after I have become employed, or to assure any benefits or terms and
conditions of employment, or make any agreement contrary to the foregoing.

I hereby acknowledge that I have been advised that this application will remain under consideration for no
more than 16 weeks from the date it was signed.

  Applicant Signature                                                         Date

  Applicant Printed Name

  Company Representative Signature                                            Date

  Company Representative Printed Name

 Company Representative Title

 Office Concierge Application Form

Pre-Employment Medical Questionnaire – Strictly Private & Confidential

 This form is part of the company’s pre-employment formalities and risk control process. The
 company is aware of its duties under the Disability Discrimination Act 1995 and intends fully to
 implement the requirements and principles of the Act. All questions concerning your health and
 disabilities are to be used only for the purpose of assessing fitness for employment. If any
 disability is declared, the Company will seek to evaluate all reasonable adjustments necessary to
 the workplace and/or the job. The information shall be kept strictly confidential and will be used
 only for medical and personnel-related purposes in the future.

 It is important that you read the questions carefully and that you answer as clearly and as
 accurately as possible, disclosing all relevant information.
 Height                 Metres            Centimetres               Weight             st         lb         kg
 Smoker                      Yes     No   Tobacco intake per day                                  (units)
 Alcohol Intake                       per week          (units)
 Please state number of days and reason for any absence due to illness or injury you have had from work /
 education in the last three years:

 Do your regard your health as:
           Excellent                              Good                                  Poor

Have you ever been?
 Rejected for employment or insurance for medical reasons                                   Yes             No
 Treated for any form of recognised mental illness within the last three years, e.g.
                                                                                            Yes             No
 depression / anxiety / stress / phobias.
 Treated for problem drinking / drug abuse within the last three years.                     Yes             No
 Please identify any toxic or dangerous substances to which you have been subjected.

 Have you had within the last three years / do you have a serious illness or
 medical condition                                                                          Yes             No

 Is there any family history of:
 High blood pressure / stroke / Tuberculosis / Epilepsy / Heart disease /                   Yes             No
 Blood disease / Diabetes / Cancer                                                          Yes             No
 Do you have a disability?                                                                  Yes             No
 If you have answered ‘yes’ to any of these questions please give details and provide us with
 relevant dates.

Office Concierge Application Form

Pre-Employment Medical Questionnaire Declaration

I understand that should I not wish to answer any question or divulge particular details that I can
discuss them in confidence prior to returning the form. I am prepared to undergo a medical
examination at the company’s request if this is required and agree that details of any
examination may be released to my own GP if the Company Doctor considers this necessary.

I declare that the questionnaire answers are true in every respect and I have not knowingly
withheld any medical information. I understand and accept that if any of the information given by
me in this questionnaire is incorrect or untrue, then the company reserves the right immediately
to withdraw any offer of employment, or terminate my employment.

I consent for the purposes of the Data Protection Act 1998 to the processing of data on my
health by the company for medical and personal related purposes including my job application.

Name                                                               Date


Office Concierge Application Form

Data Protection

We will ask in the job application form and in other documents for you to provide personal
information to enable the Company to administer or process pay and benefits, holiday leave and
sickness records, appraisals, salary reviews, disciplinary and grievance hearings, and other
matters, for the purposes of complying with its legal obligations under the contract of
employment or as required by statutory authorities (Category 1 information).

Certain personal data under the Data Protection Act 1998 is regarded as sensitive. This means
information about any employee relating to their racial or ethnic origins, political opinions,
religious beliefs or beliefs of a similar nature, membership of trade union, physical or mental
health or condition, sexual life, having committed a criminal offence or alleged to have done so,
or involvement in any proceedings for any offence committed or alleged to have committed by

Sensitive data of this kind will only be processed by the company relating to you where it is
relevant to the business for its legitimate purposes including the implementation of its
employment policies on such areas as sickness absence, discipline and grievances, harassment,
and equal opportunities. (Category 2 information).

In addition, the Company will have to provide information to other parties such as its professional
advisers as agents for and on behalf of the Company or to those who provide products or
services such as IT suppliers, pension benefits advisers or actuaries, and consultants to the
business. Information will also need to be provided to other companies within the group or to
head office. (Category 3 information). Again, information will only be supplied where it is for the
legitimate purposes of the business and is relevant to your employment.

In accordance with the provisions of the Data Protection Act 1998, the Company requests your
consent to the processing or recording of any of the above data held on computer, or under a
manual filing system (as defined under the Act), for the legitimate purposes of the business, and
in particular sensitive personal data as to the matters described above including any reports or
data as to your medical condition.

I would be grateful if you would sign, date and return as below.

I consent to the processing of personal data by the Company as described above. (Delete
where appropriate)

Category 1                          YES   NO         Category 2               YES      NO

Category 3                          YES   NO

Name                                                               Date