0 - Position Applied for

1 -  Position Applied for Other

Personal Details

2 - Title

3 - Forenames

4 - Surname

5 - Date of Birth  (dd/mm/yyyy)

6 - Gender

7 - UK National Insurance Number    

Contact Details

8 - Address Line 1

9 - Address Line 2

10 - Address Line 3

11 - Town/City

12 - Postal Code

13 - Telephone Number

14 - Mobile Number

15 - Email address

Other Details

16 - Do you currently hold a current CPCS card

17 - What plant operator tickets do you hold

18 - Plant operators tickets, other [if you hold more than one]

Equal Opportunities Monitoring

As a equal opportunities Employer, Martyn England is required under Race Equality Legislation to collect details about an applicant's ethnicity. This information is collected to fulfil that obligation and is used for monitoring purposes only.

19 - Ethnic group

Disability

Under the terms of the Disability Discrimination Act 1995 a disability is defined as a 'physical or mental impairment which has a substantial and long term effect on a person's ability to carry out normal day to day activities'.

20 - Do you consider yourself disabled? 

21 - If disabled, do you need any special arrangements to enable you to attend for interview?

22 - If so, please give details 

Rehabilitation of Offenders Act

In order to protect certain vulnerable groups within society, there are a number of posts and professions that are exempt from the provisions of the Rehabilitation of Offenders Act 1974. These include posts where, in the normal course of their duties, successful applicants will have access to persons in receipt of health services. If the post you have applied for falls within the above category, it will be exempt from the provisions of the Rehabilitation of Offenders Act by virtue of the Rehabilitation of Offenders Act (Exceptions Order) 1975.

Applicants are, therefore not entitled to withhold information about convictions which for other purposes are 'Spent' under the provisions of the act and in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the employing organisation. Any information given will be confidential and will be considered only in relation to posts to which the order applies.

23 - Have you at any time received, or had pending, a court conviction?  

24 - If yes, please give details

Employment History

Please record below the details of your current or most recent employer

Most Recent Employer

25 - Employer Name (most recent employer)

26 - Employer Address

27 - Employer Type of business

28 - Employer Telephone number

29 - Job title

30 - Employment Start Date (dd/mm/yyyy)

31 - Employment End Date (dd/mm/yyyy) if applicable

Previous Employment

32 - Employer Name (most recent employer)

33 - Employer Address

34 - Employer Type of business

35 - Employer Telephone number

36 - Job title

37 - Employment Start Date (dd/mm/yyyy)

38 - Employment End Date (dd/mm/yyyy) if applicable

Previous Employer(s) Other

Please provide brief details of any other previous employers

39 - Other Employer Details

Supporting information

Please give any further information in support of your application. This may include publications, relevant skills, knowledge, experience, voluntary activities and training etc., not mentioned elsewhere in this application form. You may also like to indicate your reasons for applying for this position.

40 - Supporting information

Referees

Referees will be required when an interview is offered. All referees will be approached only with your prior consent.

DECLARATION

The information in this form (All parts) is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. This applies equally to any medical questionnaire/forms I may complete.

41* - I agree to the above declaration.