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Declaration
References
Surname:


First Names(s):


Address Line 1:


Address Line 2:


Address Line 3:


Town or City:


County:


Postcode:


Contact Number:


Email Address:


Date of Birth:
 

Full Driving Licence:


If Yes, please give further details including dates:


Endorsements:


Are you involved in any activity which might limit your availability to work or your working hours e.g. local government?


If Yes, please give full details


Are you subject to any restrictions or covenants which might restrict your working activities?


If Yes, please give full details


Are you willing to work overtime and weekends if required?


Please give details of any hours which you would not wish to work:


Have you any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974)?


If Yes, please give full details:


You may be required, if offered employment, as part of your Application to complete a Pre-Employment Medical Questionnaire. Are you prepared to undergo a medical examination prior to employment?


Have you ever worked for this company before?


If Yes, please give full details:


Have you applied for employment for this company before?


If Yes, please give full details:


Have you had more than one week continuously off work due to sickness over the last 1 year?


If Yes, please give full details: