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					                                                                                        For Office Use Only

                                                                                         I.D No:




               APPLICATION FOR EMPLOYMENT


                                         Please affix 1
                                           COLOUR
                                          photograph
                                             here




Applicants Full Name: ______________________________________________



This application form is to be completed in your own handwriting, in BLOCK CAPITALS using a
BLACK PEN. Ensure you fully complete all sections of the application form, including signatories
where applicable. Write NO or N/A if a question does not apply to you. Applications that are not
fully completed will not be processed.




                          CONFIDENTIAL
             PLEASE COMPLETE IN FULL AND RETURN TO:
        HR Department, ProServ Security Ltd, Astra House, 23-25 Arklow Road,
                            London, SE14 6EB.
Position applied for: __________________________


1. PESONAL DETAILS
 Surname:                                                                      Date of Birth:

 First Names:                                                                  Place of Birth:

 Previous Surname:                                                             Nationality:
 Current Address:                                                              Previous Address:




 Postcode:
                                                                               Postcode:

 How long have you resided at this address?                                    How long have you resided at this address?

 (if less than 5 years please provide previous addresses for this period)
 Home Telephone No:                                                            Mobile Telephone No:

 Email Address:                                                                National Insurance No:

 If you were NOT born in the E.E.C. you will need a valid work permit or visa before we can consider
 your application. Please therefore complete the details below.

 Date of Entry:________________________                                 Place of Entry: _____________________________

 Do you have a Work Permit or Visa?                                     YES / NO

 If YES please describe the type of Permit / Visa held:                     _________________________________________

 Date of Issue: _______________________                                 Expiry Date: _______________________________


 PERSON TO BE CONTACTED IN THE EVENT OF AN EMERGENCY:

 Name : _____________________________                                       Relationship: ________________________________

 Address: ___________________________                                       Home Telephone No: __________________________

 ___________________________________                                        Mobile Telephone No: _________________________

 ___________________________________                                        Postcode: ______________________


 Do you have any relatives working for ProServ Security Limited?                                                     YES/ NO

 Have you previously applied for or obtained a position with ProServ Security Limited                                YES/ NO

 If YES to either question please provide details:__________________________________________________

 _______________________________________________________________________________________




                                                              Page 2 of 7                          QD01    Issue 8    28/04/09 HR
2. HEALTH DECLARATION
The following information is retained in the strictest of confidence.

       1.    Are you generally in good health?        Yes / No
       2.    Are you physically fit?                  Yes / No
       3.    Is your eyesight satisfactory for all normal purposes (with glasses if necessary)  Yes / No
       4.    Is your hearing normal in both ears (for telephone usage)?                         Yes / No
       5.    Is your speech defective?                                                          Yes / No
       6.    Have you been in hospital for more than two weeks in the last ten years?           Yes / No
       7.    Are you taking a course of injections, pills or drugs?                             Yes / No
       8.    Have you ever had fainting attacks, blackouts or epilepsy?                         Yes / No
       9.    Have you ever suffered mental ill health, nervous breakdown or debility?           Yes / No
       10.   Have you ever had heart trouble, rheumatic fever or high blood pressure?           Yes / No
       11.   Have you ever had kidney disease, bladder trouble?                                 Yes / No
       12.   Have you ever had arthritis, rheumatism or gout?                                   Yes / No
       13.   Have you ever had diabetes?                                                        Yes / No
       14.   Have you ever suffered a rupture?                                                  Yes / No
       15.   Have you ever had any other illnesses, allergy or disease?                         Yes / No
       16.   Do you suffer from any medical condition which may affect your ability to work?    Yes / No
       17.   Have you ever had any back or joint trouble, prolapsed disc, or factures?          Yes / No
       18.   Are you a registered disable? (If yes, state Green Card No.): _______________________________________

If you answered YES to any of the above questions, please provide details: __________________________
_________________________________________________________________________________________________

Give details of any declared illness or incapacity shown above, including any periods off work in the last three
years of more than fourteen days: ___________________________________________________________________

________________________________________________________________________________________________

Should any additional information be required from your medical practitioner, the law requires us to inform you
of our intention and to obtain written consent beforehand.

I confirm the above information is correct and complete and I agree that ProServ Security Limited reserves the
right to require me to undergo a medical examination at the Company’s expense.


Name (PRINT): ____________________________________________                  Dated__________________________

Signature: ________________________________________________


3.   DRIVER DETAILS
     1. Do you own a motor vehicle or motorcycle?                             YES/ NO

2. Do you possess a full, clean, current UK driving License?                  YES/ NO

3. Driving License No: _________________________                              Date of expiry: ________________

4. How long have you held a full driving license: _________________           Issue date: ___________________

5.   How long have you been driving in the UK?      _________________

Give details of any other endorsement or other motoring convictions: _________________________________




                                                  Page 3 of 7                    QD01   Issue 8   28/04/09 HR
4.   EDUCATION & QUALIFICATIONS
(State   name and address of last school/ college attended)

SECONDARY EDUCATION RECORD
School attended:                                   From          To                      Qualifications
_______________________________                                                  ____________________________
_______________________________                  ______         ______           ____________________________
                                                                                 ____________________________

FURTHER EDUCATION RECORD
College / University attended:                      From         To                      Qualifications
_______________________________                                                  ____________________________
_______________________________                  ______         ______           ____________________________
                                                                                 ____________________________

ADDITIONAL QUALIFICATIONS / SKILLS

First Aid:                 YES / NO         If Yes please state expiry date: ____________________________
Fire Fighting Certificate: YES / NO         If Yes please state expiry date: ____________________________
Foreign Languages: _______________________________________________________________________________
Other:____________________________________________________________________________________________


SIA LICENSES:

TYPE: __________________________ No: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                  Expiry Date: ___________
TYPE: __________________________ No: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                  Expiry Date: ___________
TYPE: __________________________ No: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                  Expiry Date: ___________


5.   REFERENCES

PERSONAL REFERENCES

Give the names and address of two persons (not former employers or relatives) who have known you for at least 2
years.

Name: ________________________________                                Name: _________________________________
Address: ______________________________                               Address: _______________________________
         ______________________________                                        _______________________________
         ______________________________                                        _______________________________

Tel. No: _______________________________                                     Tel. No:_________________________

How long known: _______________________                                      How long known: _________________


SELF-EMPLOYMENT REFERENCES

If you have been self-employed please give references of people who can confirm the details: i.e. Accountant

Name: ________________________________                                Name: _________________________________
Address: ______________________________                               Address: _______________________________
         ______________________________                                        _______________________________
         ______________________________                                        _______________________________

Tel. No: _______________________________                                     Tel. No:_________________________

Occupation: ___________________________                                      Occupation: _____________________


                                                  Page 4 of 7                    QD01   Issue 8   28/04/09 HR
6. EMPLOYMENT RECORD

State all periods of employment, self employment and unemployment for the last 10 years, or since leaving School.
For any periods of unemployment, state the address of the Unemployment Benefits Office at which you reported.

Start with present situation.

 Employers Details              Employment Details                                    Dates                   Office Use
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:
 Name:                          Position Held:
                                                                                      From:
 Address:                       I.D / Employee No:
                                Reporting to:                                         To:
                                Reason for leaving:

 Telephone No:                  Wage:

                                        If necessary, continue on additional sheets

May we approach your present employer for a reference now?           YES / NO



                                                   Page 5 of 7                         QD01   Issue 8   28/04/09 HR
7. OFFENCES, CAUTIONS AND CONVICTIONS

      1.   Have you ever been cautioned by the Police?                                                            YES / NO

      2.   Have you ever been convicted, fined or had any order made against you
           by a Criminal, Civil or Military Court?                                                                YES / NO

      3.   Are you aware of any Police investigations in which you may be involved?                               YES / NO

If the answer to either question 1, 2 or 3 above is YES, give details: _______________________________________
________________________________________________________________________________________
____________________________________________________________ ______________________________

N.B. Disclosure is not required where there is a conviction to which the provisions of the Rehabilitation of Offenders Act 1974 apply. Failure
to disclose an unspent conviction may result in summary dismissal.

8.    MILITARY SERVICE

Please give details of all periods of service in the Forces (Regular or Reserve), full time Civil Defence etc., that
you have undertaken.

Description of Service (RN, Army, RAF, MN, TA, RM): ____________________________________________

Regiment, Branch or Division: _______________________________________________________________

Date of Joining: ___________________________                                Personal / Regimental No. __________________

Rank: Date of Discharge / Retirement: ________________________________________________________

Decorations & Medals: Conduct / Character on leaving: __________________________________________

_______________________________________________________________________________________

9. FINANCIAL LIABILITIES

Have you any outstanding debts or attachments of earnings?                                                 YES / NO

If YES, give details: _______________________________________________________________________
________________________________________________________________________________________

Have you ever been declared bankrupt / insolvent?                                                          YES / NO

If YES, give details: _______________________________________________________________________
________________________________________________________________________________________

Are you the subject of any County Court proceedings?                                                       YES / NO

If YES, give details: _______________________________________________________________________
________________________________________________________________________________________


10.    UNIFORM SIZES

                                                                                                                      Shoe:
Male            Neck:               Chest:               Inside Leg Length:                Waist:


Female          Waist:              Bust:                Dress Size:                       Leg length:                Shoe:



                                                             Page 6 of 7                            QD01    Issue 8   28/04/09 HR
DECLARATION

Please read this carefully before signing this application.

I CERTIFY that I have read the instructions for the completion of this personal summary and that the
information is correct and complete to the best of my knowledge and belief.

I ACKNOWLEDGE that any misinterpretation of the information provided by this form shall constitute
misconduct sufficient to warrant immediate termination of any employment I may have entered into with the
Company.

I FURTHER CERTIFY that, unless otherwise stated, I have never been convicted of a criminal or civil
offence nor been dismissed from my employment for misconduct.

I UNDERSTAND that employment with the Company is subject to satisfactory security screening in
accordance with BS 7858 and in the course of the Company’s Screening Process I may be required to
obtain a Statutory Declaration on my own behalf and at my own expense in respect of the information
furnished by me in completing this application.

I ACKNOWLEDGE that the completion of this form in no way binds the Company to offer me employment
and that no contractual relations will exist between us until such time as I have signed a form of Contract or
accepted in writing the terms of a letter of appointment.

I UNDERSTAND that any Contract hereafter signed by me or letter of appointment issued by ProServ
Security and accepted by me shall be construed to mean that I am appointed on probation for a period not
exceeding 6 months.

I UNDERSTAND that during such period of probation any Contract written or implied shall be terminable by
me or by the Company by not less than one week’s notice expiring at any time.

RECRUITMENT POLICY
It is the Company’s policy to employ the best qualified personnel and provide equal opportunity for the
advancement of employees including promotion and training and not to discriminate against any person
because of race, colour, national origin, sex, marital status or disability.

I HEREBY authorise the Company to seek references from previous employers, Schools/colleges, personal
referees or Government Agencies, including Employment Benefit Offices etc to verify the information I have
provided to support this application and release the Company and referees from any liability caused by
giving and receiving information.

I HEREBY authorise the Company to make a consumer information search with a credit reference agency,
which will keep a record of that search and may share that information with other credit reference agencies.

For data protection purposes, I understand that some of the information I have provided in this application
will be held on computer and some, or all, will be held in manual records. I agree, to the Company
processing my personal data, and where necessary, my sensitive personal data, subject to the provisions of
the current legislation.


SIGNATURE: _________________________________                     DATE: ___________________________


PRINT NAME: ________________________________

                  (Name and Initials in block letters)




                                              Page 7 of 7                       QD01    Issue 8   28/04/09 HR

				
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