Name *

First Name

Last Name

Date Of Birth *

MM/DD/YYYY

MM

DD

YYYY

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

SIA Expiry Date

MM/DD/YYYY

MM

DD

YYYY

Personal Reference *

Please provide the Name, Address, Postcode, Tel no., occupation of someone who could provide a personal reference. Please include how long you have known your referee

First Name

Last Name

Personal Reference Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Reference Telephone No. *

Country

(###)

###

####

Work Reference *

First Name

Last Name

Work Reference Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Reference Telephone No. *

Country

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Telephone No. *

Country

(###)

###

####

Read & Agree *

DECLARATIONS I certify that to the best of my knowledge, the information that I have given in my application for employment is true and complete and understand that any false statement or omission to the company or its representatives may render lead to termination of employment without notice. I understand and agree that if so required I will make Statutory declaration in accordance with the provisions of the Statutory Declarations Act 1835 in confirmation of previous employment or unemployment. I authorize the company or its agents to approach the Government agencies, former employers, educational establishments, criminal justice agencies and personal referees for information relating to and verification of my employment/unemployment record. I consent to the company’s reasonable processing of any personal information obtained for the purposes of establishing my medical condition and future fitness for my duties. I accept that I may be required to undergo a medical examination where requested by the company. Subject to the access to Medical Reports Act 1988, I consent to the results of such examinations to be given to the company and authorise the company to make a consumer information search with a credit reference agency, which will keep a record of that search and may share that information with other credit agencies. I further declare that the documents that I provide as proof of my identity, proof of address, proof of right to work and any other documents that I provide are genuine and give my consent for these documents to be examined under a UV scanner or similar device. I acknowledge that any falsified documents may be reported to the appropriate authority. DATA PROTECTION ACT 1998 The company will use the information you have given on your application form (together with any information which we obtain with your consent from third parties) for assessing your suitability for employment. It may be necessary to disclose your information to our agents and other service providers. By returning this from to the company you consent to our processing personal data about you where this is necessary, for example information about your credit status, ethnic origin or criminal offences. You also consent to the transfer of your information to your current and future potential employers where this is necessary (this maybe to companies operating abroad if you apply for work outside of the United Kingdom.) Your information will be held on our computer database and/or in our paper filing systems. By signing below you agree to this process and confirm that you do not have a criminal record subject to the current rehabilitation of Offenders Act and any amendments. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected. DISCLOSURE You are applying for a position of trust and in the event of being offered employment by the company we may apply for a disclosure. However, having a criminal record does not necessarily bar you from employment. For more information ask a member of staff for a copy of the CRB code of Practice/Disclosure Scotland and/or Company our policy statement regarding ex offenders. Disclosure information is treated in a sensitive way and is restricted to those who need to see it to make a recruitment decision. By signing this document you allow the company to see a copy of the disclosure. The Disclosure information is not retained i.e. it is disposed of within the timescales recommended in the CRB Code of Practice. By signing below you agree to this process. SCREENING Any offer of employment is subject to satisfactory screening, that the applicant consents to being screened and will provide information as required. That the information provided is correct, and the applicant acknowledges that any false statements or omissions could lead to termination of employment. I confirm that, to the best of my knowledge, the information I have given on this form is correct.

Agree