Application Form For Employment
Where advertised/Informed by:
* Title:
Mr.
Mrs.
Miss
Ms.
* Surname at Birth:
* First Name:
* Surname:
* Place of Birth:
Any other Surnames Used:
* Nationality:
If not born in the EU Date & Place of Entry:
* Date of Birth:
dd/mm/yyyy
* National Insurance Number:
Work Permit / Visa:
* Address 1
Address 2:
* Town/City:
* County:
* Postcode:
Telephone number:
Mobile Phone Number:
PREVIOUS ADDRESS - if less than 3 years at current address
Address 1
Address 2:
Town/City:
County:
Postcode:
DRIVING LICENCE
* Holder of current driving licence?:
Yes
* Do you have own transport?
Yes
* Do you have any motoring offences?:
Yes
If Yes, please give details:
* Name & Address of Schools, Colleges, University's & Dates Attended:
List any other relevant courses/qualifications. Please include training provider and dates attended
EMPLOYMENT RECORD
* For BS7585 Screening, please complete your employment record for 5-10 years minimum
Please start with your most recent/current employer or benefit claim. The name, address and telephone number of your previous employers. Also your signing-on office, benefits claimed and job title.
Dates From - To
Employer Name Address & Telephone OR Benefits Office
Your Post ion & Outline of duties OR Benefits Claimed
Reason for Leaving
MEDICAL INFORMATION
* Are you fit and healthy?:
Yes
* Do you suffer any serious medical conditions?:
Yes
If yes, please give details
* Are you registered disabled?:
Yes
Are you taking any medication/receiving any medical treatment?:
Yes
If yes, please give details
May we request medical information from you GP if necessary?:
Yes
PERSONAL REFERENCES - Please supply us with references of 2 people you have known for 5 years or more (not relatives).
BACKGROUND INFORMATION
Please list any pending or current convictions, prosecutions, bankruptcies or other offences (excl. motoring).
Date of Conviction
Offence
Sentence
dd/mm/yyy
dd/mm/yyy
Have you ever been dismissed for misconduct by an employer?:
Yes
If yes, please give details
SIA LICENCE INFORMATION
* Do you hold a current SIA Licence?:
Type of licence held (e.g. Security Guarding):
Expiry Date
dd/mm/yyy
Is this licence for a Front Line Operative?:
SIA Licence Number:
STATEMENT CONFIRMATION
I confirm that to the best of my knowledge, the information I have given is complete and correct. I understand that misrepresentation of facts is grounds for immediate dismissal and renders me liable for prosecution. I confirm that I clearly understand that I am required to work days, nights and weekends as laid down by Sector Security Services Limited. I confirm that I am not in any other employment or attending any full-time education programme. If offered employment, it will be initially for a probationary period of three months.
I authorise the Company to approach any Government Agencies, former employers, credit agencies and referees to verify and support the information given and will supply a Statutory Declaration if required.
*
