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Address including postcode
Position Applying for*
Do you have the right to work in the UK?
Do you have a valid driving licence?
Do you have any endorsements on your driving licence?
If yes please give details – Date of conviction, penalty points, disqualification?
Do you have access to a vehicle for business purposes?
Do you have a criminal record?
If yes please give details
Do you have any qualifications relevant to the role applied for?
If yes please give details - Date achieved, qualification, etc.
Preferred number of hours per week
Please tell us why you think you would be suited to the role applied for
Employment record. Please list chronologically, starting with your current or last employer in the following format:
Name and address of employer and nature of business:
Job title and responsibilities:
Reason for leaving:
Disability Discrimination Act 1995
Section 1 of this Act describes a disabled person as a person with a ‘physical or mental impairment which has a substantial or long-term effect on his/her ability to carry out normal day-to-day activities’.
Using this definition, would you consider yourself to be disabled?
If yes, do you require any special arrangements to be made to assist you if called for interview? Please provide details:
I certify that all information which I have provided is correct. I understand that any false information given may result in a job offer being withdrawn. Yes