Application Form

Your application will be treated in the strictest confidence.
Please ensure all information requested is completed as incomplete applications will be rejected.

Pentax House, South Hill Avenue, Harrow, HA2 0DU

T: 07428738881

Position applied for

Date of application

Location

How did you hear about this company?

Last Name

Middle Name

First Name

Title

Gender

Known by any other names?

Date of Birth

Email Address

Mobile Number

Current Address

Bank Name

Acct. Name

Acct. No.

Postcode

Sort Code

Place of Birth (Inc. Country)

Nationality

Languages known

National Insurance Number / Ref Number

Passport Number (If you hold a current/valid passport)

Work Permit / Settlement Status for the UK (Upload in PDF if applicable to you)

Do you hold a current/valid DRIVING LICENSE/Provisional? IF YES, provide details

Do you have current Endorsements? IF YES, provide details

Have you ever been fined, cautioned, sentenced to imprisonment, placed on probation, discharged on payment of costs, or had any order made against you by a criminal, civil or military court or public authority? IF YES, provide details

Note: - Failure to disclose information in this regard (including any cautions) is regarded as a criminal act under the Fraud Act 2006 which carried maximum sentence of 5 years imprisonment.

Have you had any time off work through illness/injury in the past 2 years? IF YES, provide details

Does your health prevent you from performing certain types of work? IF YES, provide details

Education History

Begin from Secondary school and include any current courses you are attending.

From

Name & Address of School/College/University

Qualifications Attained

Name of the Teacher

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Other Qualifications, courses or training you have attended (Please include details of any courses which you are currently attending – including address & dates)

Employment History

Start with the most recent and working backwards. Please state the details below with all periods of Employment, Unemployment & Military Service to cover the last 5 years. It is important that you give exact dates, full name, address, email/contact numbers to enable us to complete the necessary checks required. An incomplete background check may result in employment and/ or completion of probationary period being denied

From

Name & Address of Employer

Job Title

Reasons for leaving

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When can you start work?

CRB

Are you willing to undergo a full enhanced CRB Disclosure with this application for work?

Are you willing to pay the required fee of £62.20 for a CRB Disclosure and ISA check?

Address (last 5yrs; Inc. Dates)

Next of Kin

Relationship

Contact No

Address

In the next 12 months, are there periods when you will be UNAVAILABLE for work? (i.e., Holidays, Medical appointments etc? IF YES, provide details.

Briefly state why you would like to work in this job and add anything which you wish to support application

NOTE: If you lived in this address less than 5 year, then please provide us previous address.
If you have job gap, then please let us know the reason.

References

Please provide the names and details of two referees one must be a previous/recent employer.

Name

Address

Telephone

Occupation

Relation

How long known?

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Declaration

I declare that the information given on this form is completed and accurate and to the best of my knowledge Any false statement may lead to refusal of employment or disciplinary proceedings or summary dismissal. I understand that any engagement entered is subject to a probationary period, satisfactory references, and documentary evidence of a National Insurance Number/other proof of the right to work in the UK and a satisfactory medical examination (if required). I have no criminal convictions other than those disclosed on the form. I authorise you to approach my former employers, education establishments, Government agencies, personal credit references agencies and personal referees for verification of information. I accept final offer of employment is conditional on satisfactory Criminal Record Check / Counter Terrorist Check.

Name

Date

Education History

Employment History

CRB

References

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