London Overground Rail Operations Ltd by maclaren1

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									External Employment Application Form

As an equal opportunities employer, we welcome applications from all sectors of the community. We are committed to an
effective implementation of our Equal Opportunities policy. Applicants are considered on the basis of their suitability to
the post, regardless of their race, belief, colour, ethnic or national origins, sex, marital status, disability, gender, age,
nationality, sexual orientation, gender re-assignment, religion, creed, class or trade union membership.


To be considered please ensure your application form is fully completed and is readable. To be considered for
the position you are applying for, the completed form must be returned by the closing date advertised.


Please return this form to: Personnel Department, Chiltern Railways Company Ltd, Great Central House, Marylebone
Station, Melcombe Place, London, NW1 6JJ.




                                  THE VACANCY YOU ARE APPLYING FOR


Position applied for:


Job Reference Number:
ie. R01/09


Location of position:




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                                             PERSONAL DETAILS


Title:                   Mr/Mrs/Miss/Ms/Dr                 Sex:            Male                      Female
Forenames:

Middle Name(s):

Surname:

Home Address:

Town:

County:

Post Code:

Home Telephone No.

Work Telephone No.

Mobile No.

Email:

National Insurance No.




                             PRESENT OR MOST RECENT EMPLOYMENT

Employer’s name:

Employer’s full
address:

Date employment                                      Date left (if applicable):
commenced:

Position held:                                       Notice required to terminate
                                                     present employment:

Reason for leaving /
wishing to leave:

Please summarise
main duties &
responsibilities:




                                         EMPLOYMENT HISTORY

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Please provide employment details over the last 5 years including voluntary or unpaid work, and periods of
unemployment or any intervals between appointments. Please start from the most recent first.

Employer’s Name & Address:               Start Date:                        Date Left:




Position held:
Reason for leaving:

Main Duties & Responsibilities:




Employer’s Name & Address:               Start Date:                        Date Left:




Position held:
Reason for leaving:

Main Duties & Responsibilities:




Employer’s Name & Address:               Start Date:                        Date Left:




Position held:
Reason for leaving:

Main Duties & Responsibilities:




                                  EDUCATION AND QUALIFICATIONS


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Please give details of your academic and vocational qualifications/ skills starting with the most recent qualification gained/
expected. Please note that we will want to see copies of your certificates should your application be successful.


  Names of School, College,                   Dates                                                         Grade Attained or
                                                                       Qualifications gained
   University, etc attended                                                                                    Expected
                                       From           To




                           PROFESSIONAL MEMBERSHIP AND REGISTRATION

Vocational categories include the following: Customer services, Health & Safety, Railway Specific, IT & other professional
development (HR, finance & law)



                                           Level of
         Organisation                                                              Expiry / Renewal Date
                                          Membership




                                      SKILLS, EXPERIENCE AND QUALITIES
Please refer to the job description and person specification to answer the following questions.




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CAREER CHOICE & MOTIVATION
Explain why you have applied for this job, and provide evidence of why you believe you are the best candidate for
this job.




SKILLS & EXPERIENCE RELEVANT TO THE ROLE TO WHICH YOU ARE APPLYING
Please use the space below to write about your skills and experience that you have learned in other jobs and how
they will be relevant to the position you are applying for. (This may include different languages you speak, customer
service experience & other skills)




ACTIVITIES & INTEREST
What activities and leisure interests are you currently involved in, and what have you learnt about yourself from
your involvement in these? (Explain how this is relevant to the role to which you are applying)




                                                  REFERENCES

All appointments are subject to the receipt of satisfactory references. Please give details of two referees (other than
family members or social friends), one of which should be your current/most recent employer, and covering at least 5


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years of your employment history. If you are a recent school/college leaver, one should be the Headteacher of your last
school. References will only be taken up once the offer of employment has been accepted unless agreed otherwise.

Name of Organisation                                           Name of Organisation


Name of Referee                                                Name of Referee


Job Title of Referee                                           Job Title of Referee


Address                                                        Address




Post Code                                                      Post Code

Contact telephone number:                                      Contact telephone number:
Fax Number:                                                    Fax Number:
E-Mail Address:                                                E-Mail Address:

Dates employed or known:                                       Dates employed or known:
From: __________________           To: _________________       From: __________________          To: _________________
Indicate the type of reference:                                Indicate the type of reference:
Employment/ Academic/ Character                                Employment/ Academic/ Character
Relationship to Referee:                                       Relationship to Referee:



                                                        HEALTH

 Height                                cm                        Weight                            kgs
Do you have defective colour vision? *                          Do you have impaired hearing? *

Yes                                             No              Yes                                               No
Have you ever failed Drug & Alcohol Screening?                  Have you had any illnesses in the past three years that
                                                                has required you to take time off work?

Yes, If yes, please provide date:           No                  Yes                                         No
Have you had corrective eye laser surgery *                     Do you intend to have laser eye surgery in the future? *


Yes, If yes, please provide date:         No            Yes, if yes, please provide date:                         No
Do you have any medical problems that often cause you to be absent from work?

Yes, if yes, please provide details:                                                                              No

* - To be completed only when applying for a Safety Critical Post including Qualified or Trainee Train Drivers.

Are you able to work shifts including nights and weekends?                Yes [ ]                    No [ ]


                                               OTHER INFORMATION


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Are you currently eligible to work full-time in the UK?            Yes                        No

Please state what original documentation you can provide in order to demonstrate this (e.g. Passport or any
form of work permit issued).


Immigration and Asylum Act 1996 – In accordance with Section 8 of the Immigration and Asylum Act 1996, it is a criminal
offence to employ someone who is subject to immigration control and does not have the right to work in the UK.

Do you have any armed service/public duty commitments?           Yes                          No




At Chiltern Railways we are always interested in how our applicants were initially made aware of positions within
the company. Please tick the relevant box below,

Employment Agency                      Chiltern Railways website

Job Centre                             Job Fair/Careers Convention

Speculative Application

Press Advert                           If so, which paper/ publication?

From Chiltern Staff                    If so, please give name

Other (please specify)




Dates of any pre-booked holidays in the next 3
months:




                                                DECLARATIONS

REHABILITATION OF OFFENDERS ACT 1974




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You need not enter any details of any offence(s) which are spent under the terms of the Rehabilitation of Offenders Act. If
you are uncertain whether your offences are spent or not please contact your local Citizens Advice Bureau for
confidential advice.

Any false statement will disqualify you from your employment or, if discovered after employment has commenced, will
render you liable for instant dismissal.


Have you any unspent criminal convictions? This includes motoring offences.
                                                                                              Yes [ ]                No [ ]

If yes, please give details below.

                                          Nature of offence or
              Date                      attachment of earnings                Sentence or court order with costs
                                                 order




If you are successful for a role, Chiltern Railways may conduct a criminal record check.
Please confirm your agreement to this check.                                                            Yes [ ]       No [ ]



DECLARATION

In accordance with the Data Protection Act 1998 we are unable to collect and process the data on this form without your
explicit consent. If you are happy to provide the above information please confirm your consent by signing the form
below. Please note that if you choose not to provide your explicit consent then due to the nature of the position you have
applied for, we will be unable to consider your application further. Any sensitive data which you do provide will be treated
in the strictest confidence.

I confirm that the information provided may be gathered and processed for the purpose of selecting for this post
and managing any subsequent employment with the business. The information given on this form is, to the best
of my knowledge, true and complete and the form has been completed by myself (in own handwriting if not
typed). I accept that providing deliberately false or incomplete information may result in my rejection for
employment or subsequent dismissal.


Signed: *(If form sent by email, it will be regarded as signed declaration)        Date:



Print Name:




                                                 EQUAL OPPORTUNITIES POLICY

Chiltern Railways aim to ensure that we attract, recruit and develop the best available people irrespective of their race,
belief, colour, ethnic or national origins, sex, marital status, disability, gender, age, nationality, sexual orientation, gender


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re-assignment, religion, creed, class or trade union membership. The information supplied in this section will be treated
separately to the rest of your application and will not be associated with your other details when your application is
assessed. To help us monitor this, please fill in the form below.

NAME & AGE

Name: ______________________                 Please tell us your age: _______           Date of Birth:     /    /


ETHNIC ORIGIN
Please identify your ethnic status. (Please tick the applicable box)

White – British                   Mixed – White & Black Caribbean           Asian British - Indian

White – Irish                     Mixed – White & Black African             Asian British - Pakistani

White – Other                     Mixed – White & Asian                     Asian British – Bangladeshi

Black British – Caribbean         Mixed – Other                             Other Asian Background

Black British – African                                                     Chinese

Black British – Other                                                        Other


DISABILITY
Do you have a health problem or disability which is relevant to your job application?       Yes                     No


If yes, do you have any special requirements if you are asked to attend an interview?       Yes                     No

If yes, please give details:




If you have a health problem or disability which is relevant to your job application, could an adjustment be made to assist
you in the workplace?     Yes                No


If yes, please give details:




FAITH
What, if any, is your faith? The categories for faith, listed below are taken from the 2001 Census. If you feel that your faith
is not represented, please detail in the “Other” box. Please tick one box from the list below:
    None                              Jewish                            Hindu
    Buddhist                          Muslim                            Prefer not to say
    Christian                         Sikh                              Other, Please specify: ______________________




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