POST APPLIED FOR
Your Name (required)
Your Address (Including postcode)
Your mobile number
Your Email (required)
Your date of birth
National Insurance Number:
Do you have children?
Next of kin (Please give name, relationship to you and a contact phone number for them)
Where did you find out about the vacancy
Are you male or female?
white Britishwhite Irishother whiteblack/black BritishAsianAsian BritishChinesemixedother
Do you consider yourself to be disabled under the Disability Discrimination Act? (The Disability Discrimination Act (1995) defines disabilty as "a physical or mental impairment which has a substantial and adverse effect on a person's ability to carry out day to day activities")
Right to work in the UK?
If yes, which is applicable?
British or EU citizenvisa entry clearance giving right to work
Work permit required?
Permit valid until?
Type your name to sign
Please complete this section as accurately as you can, ticking the appropriate boxes and answering questions clearly.
Your doctor's name and address (Including postcode)
Any other long term illness/conditions?
Pacemaker fitted? (company uses powerful magnets)
Are you at present taking any medication?
If yes to the above, please specify:
Are you colour blind?
Do you wear spectacles?
Do you smoke?
If yes, quantity per day;
What is your weekly alcohol consumption (units)?
Please check the box below: