JOB APPLICATION FORM
JOB APPLIED FOR:
Application for Employment as:
Have you previously applied for YES / NO. If yes, please give details a position with Omni Serv?
PERSONAL DETAILS:
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Surname |
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Date of birth |
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Gender |
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National |
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Marital status |
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Insurance No |
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Phone Number |
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Phone Number |
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(Home) |
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(Mobile) |
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Home Address |
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post |
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code) |
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E-Mail Address |
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Nationality |
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Do you have the right to live and work in the |
YES / NO |
UK indefinitely? |
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Do you hold a valid UK working visa? |
YES / NO |
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If yes, please state the expiry date |
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Do you |
require any |
YES / NO |
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special arrangements |
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to be made for your |
If yes, please give brief details of the effects of your disability on your |
interview |
on account |
day-to-day activities and any other information that you feel would |
of a disability? |
help us to accommodate your needs during your interview. |
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Have you ever been |
YES |
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NO. If yes, |
please give |
details below of any unspent |
convicted of a criminal |
convictions: |
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offence? |
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Do you have any relatives |
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YES / NO |
Relative’s |
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working for Omni Serv? |
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name |
and |
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relationship |
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Do you hold a full clean |
UK |
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YES / NO |
Details of any |
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driving licence? |
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endorsements |
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EDUCATION & QUALIFICATIONS:
Secondary School / College / |
Dates (Most recent |
Exams taken and |
University attended |
dates first) |
qualifications gained |
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Further training courses or |
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programmes attended since full |
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time education |
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Foreign languages spoken fluently |
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HEALTH DECLARATION: |
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Name and address of your |
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General Practitioner |
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I am willing to undergo a medical examination if required and I declare that the information I provide on this form is correct to the best of my knowledge and I agree that the Omni Serv’s doctor may consult my own General Practitioner about any of the information given on this form.
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Please answer Yes or No to the following Questions and give further details as appropriate:
1Do you have any physical or mental impairment that could be classed as a disability under the Equality Act 2010?
2Have you ever received disability compensation or a disability pension?
3Are there any medical reasons why you should not work shifts?
4Are you able to carry out strenuous physical work, including climbing ladders, working from scaffolding, bending, lifting and carrying?
5Have you ever had to give up any previous job for medical reasons?
6Have you been off work continuously for more than a month during the last five years for medical reasons?
7Have you ever had any operations requiring hospital admission for 5 or more days?
8Is your eyesight normal (with glasses if worn)?
9Is your hearing normal?
10Do you regularly take tablets or medicine? If so, what do you take?
11Have you ever had any of the following medical conditions? (Please show Yes or No against each condition listed)
Diabetes?
Tuberculosis?
Angina?
Any other heart trouble? Raised blood pressure?
Peptic, gastric or duodenal ulcer? Indigestion for more than one week?
Back trouble, lumbago, sciatica, "slipped disc"? Epilepsy, recurring blackout or fits?
Bronchitis, asthma, pneumonia?
Dermatitis, eczema or any other skin trouble?
12Do you suffer from any of the following? (Please show Yes or No against each condition listed)
Migrane or severe recurring headaches?
Anxiety, depression or any other nervous complaint? Fainting attacks or giddiness?
Ear trouble, discharging or infected ear? Kidney trouble or urinary infection?
13If you have answered Yes to any of the Questions 1 to 12 above, please give full details below:
14Have you ever had any other serious illnesses not recorded above? If yes, please give full details below:
15Have you consulted your GP or any other doctor about your health during the past 12 months? If yes, please give full details below:
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EMPLOYMENT RECORD:
IMPORTANT NOTE REGARDING EMPLOYMENT REFERENCES
Please give details of your present or most recent employment first, then your preceding employment, finishing with your earliest job. It is a requirement of the Company that you will need to provide a full 5 years’ referencing history. This must include a written explanation below of any gaps in your history of more than 28 days with a supporting gap referee who can be a friend (not a relative and not living at the same address), known to you for at least 2 years who can confirm what you were doing during this period. Please continue on a separate page, if necessary, to show the full details.
Include details of any self employment, unemployment, military service and part time work. Be sure to give full addresses and dates.
If there is any period of unemployment, please give the address of the Unemployment Benefit Office to which you reported.
Employment dates (Most recent dates first) (dd/mm/yy)
Employer’s full name, address and telephone number
Name of the person you reported to and their job title
REFERENCES:
Personal Reference
You will need to provide details of a Personal Referee. Therefore, please provide the name of an individual who is not related to you and who will be able to provide a character reference for you.
In addition, for any periods of self employment, you will need to provide a different referee who can confirm your self-employment details, usually an accountant or a solicitor.
Personal Referee
Name:
Address:
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Contact Phone Number: |
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How do you know this person? |
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__________________________ |
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How long have you known this person? |
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__________________________ |
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Self Employment Reference |
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Name: |
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Address: |
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Postcode: |
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Contact Phone Number: |
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How do you know this person? |
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__________________________ |
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How long have you known this person? |
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5 |
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I can confirm that the above details accurately represent my employment history.
I give my permission for Omni Serv, or any external consultancy acting on their behalf, to approach all referees given on this application form for references. This includes any educational establishments and Government agencies.
DECLARATION
I confirm that, to the best of my knowledge and belief, the information that I have given above is true and complete. I understand any false statement or omission may be grounds for withdrawing an offer of employment to me or render me liable to dismissal without notice. I also understand criminal charges may be brought against me if appropriate.
Apart from any convictions I have disclosed on this form I have never been convicted of any criminal offence, other than any criminal convictions treated as spent under the provisions of the Rehabilitation of Offenders Act 1974.
I have not been dismissed from my employment for any misconduct.
I accept that I may be required to undergo a medical examination where requested by the Company and I consent to the results of such examination being given to the Company.
I agree to a Criminal Records Check (CRC) being obtained from Disclosure Scotland to enable an Airport ID pass to be issued. In addition, I understand that an overseas CRC will be required for any country I have resided in for 6 months or more in the preceding 5 years.
If I have applied for a Security role, I accept that the Department for Transport will carry out a Counter Terrorist Check (CTC) and my employment is conditional upon a satisfactory outcome of such a check.
Print name:
DATA PROTECTION:
Information from this application may be processed for purposes registered by the Employer under the Data Protection Act 1998. Individuals have, on written request, the right of access to personal data held about them.
For the purposes of compliance with the Data Protection Act 1998, I hereby give my consent to Omni Serv processing the data supplied in this questionnaire for the purpose of recruitment and selection.
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