application form

Application Form
1. When fully completed this Application for Employment Form ensures compliance with British Standard 7858 – Security Screen of Individuals Employed in a Security Environment – Code of Practice

2. Your Security Screening cannot begin if you fail to either fully complete or sign this Application for Employment Form. Security screening will be the minimum of 5 years.

3. Please answer All questions.
Where did you hear about the post?
Position applied for?
MrMrsMissMs
Name

First NameLast Name
Surname at Birth (if different from above)
Date of name change

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at current address
Phone Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
Email Address
Place of Birth
Nationality
National Insurance Number
Passport Number
YesNo
YesNoN/A
Date of Expiry

DayMonthYear
Date
YesNoN/A
Type of Licence
Expiry Date

DayMonthYear
Date
SIA Licence Number
YesNo
Type of Licence
Expiry Date

DayMonthYear
Date
SIA Licence Number
YesNo
Type of Licence
Expiry Date

DayMonthYear
Date
SIA Licence Number
YesNo
Type of Licence
Expiry Date

DayMonthYear
Date
SIA Licence Number
YesNo
Type of Licence
Expiry Date

DayMonthYear
Date
SIA Licence Number
YesNo
YesNo
If Yes please provide details
YesNoN/A
If Yes please provide details
YesNo
YesNoN/A
YesNo
Expiry Date

DayMonthYear
Date
PERSON TO BE CONTACTED IN AN EMERGENCY
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
Work Number

Area CodePhone Number
DRIVING LICENCE
FullProvisionalNone
CarMotorcycle
Licence Number
YesNo
If Yes please provide details
Please provide details of motoring convictions in the last 5 years
Number of Points currently on Licence
OFFENCES/CAUTIONS/CONVICTIONS
YesNo
If Yes please provide details
YesNo
If Yes please provide details
YesNo
If Yes please provide details
FINANCIAL (BS7858 REQUIRES THAT WE CONDUCT A CONSUMER INFORMATION CHECK WITH A CREDIT REFERENCE AGENCY)
YesNo
If Yes please provide details
YesNo
If Yes please provide details
Character References

DETAILS OF 2 PEOPLE WHO ARE WILLING TO ACT AS CHARACTER REFERENCES (NOT FORMER EMPLOYERS OR FAMILY/RELATIVES OR A PERSON LIVING AT YOUR ADDRESS) WHO HAVE KNOWN YOU FOR AT LEAST 5 YEARS. WE MAY APPROACH YOUR CHARACTER REFEREES TO ASSIST US IN VERIFYING YOUR WORK HISTORY
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email (Required)
example@example.com
Phone Number

Area CodePhone Number
How Known
Years Known
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email (Required)
example@example.com
Phone Number

Area CodePhone Number
How Known
Years Known
Professional Reference

DETAILS OF 1 PERSON WHO IS WILLING TO ACT AS A PROFESSIONAL REFERENCE, WHO HAS KNOWN YOU FOR AT LEAST 5 YEARS. WE MAY APPOACH YOUR PROFESSIONAL CHARACTER REFEREE TO ASSIST US IN VERIFYING YOUR WORK HISTORY
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email (Required)
example@example.com
Phone Number

Area CodePhone Number
Company
Position
Education Record
School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Qualifications
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
College Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Qualifications
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
University Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Qualifications
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
Armed Services Record

Only complete if applicable
YesNoN/A
ArmyNavyAir ForceOther
Please Specify
Service Number
Rank
Unit/Regiment
Conduct on Discharge
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
Please give details
Self Employed or Company Director
YesNo
YesNo
Please give details of people who can confirm this
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Employment Record

STATE ALL PERIODS OF EMPLOYMENT, UNEMPLOYMENT, AND SELF EMPLOYMENT FOR THE LAST FIVE YEARS OR SINCE LEAVING FULL TIME EDUCATION. FOR ANY PERIODS OF UNEMPLOYMENT STATE THE ADDRESS OF THE UNEMPLOYMENT BENEFIT OFFICE AT WHICH YOU REPORTED AND THE TYPE OF BENEFIT CLAIMED, e.g JOB SEEKERS ALLOWENCE, INCAPACITY BENEFIT ETC START WITH YOUR CURRENT EMPLOYMENT
Name & Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Position Held
Reporting To
Salary
Reason For Leaving
YesNo
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
Name & Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Position Held
Reporting To
Salary
Reason For Leaving
YesNo
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
Name & Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Position Held
Reporting To
Salary
Reason For Leaving
YesNo
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
Name & Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Position Held
Reporting To
Salary
Reason For Leaving
YesNo
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
Name & Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Position Held
Reporting To
Salary
Reason For Leaving
YesNo
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
YesNo
Please bring this information to the interview if you are selected
Declaration

Please read carefully before signing this application
I understand that employment with the company is subject to satisfactory references and security screening in accordance with BS 7858, for a minimum of 5 years and subsequent issue of a relevant SIA licence which is required to work in the security industry. I undertake to co-operate with the company in providing any additional information required to meet these criteria.

I authorise the company to approach previous employers, schools/colleges, character referees or government agencies to verify that the information I have provided is correct.

I understand and agree that if so required I will make a statutory declaration in accordance with the provisions of the statutory Declarations Act 1959, in confirmation of previous employment or unemployment.

I understand that some of the information I have provided in this application will be held on a computer and some or all will be held in manual records.

I consent to the company’s reasonable processing of any sensitive personal information obtained for the purposes of establishing my medical condition and future fitness to perform 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 Records Act 1988, I consent to the results of such examinations to be given to the company.

I hereby certify that, to the best of my knowledge, the details I have given in this application form are complete and correct.

I understand that any false statement or omission to the company or its representatives may render me liable to dismissal without notice.
Signature

Clear
Print Name
Date

DayMonthYear
Date
Diversity Data Capture

To be completed by the applicant
WhiteWhite EuropeanWhite otherBlack AfricanBlack CaribbeanBlack BritishBlack OtherAsian IndianAsian EuropeanAsian BangladeshAsian BritishAsian PakistaniAsian OtherChineseChinese BritishChinese OtherUndisclosedOther
YesNo
If ‘YES’ please state, the nature of your disability and if there are any reasonable adjustments we could consider to help you perform your job
Signature

Clear
Print Name
Date

DayMonthYear
Date
Should be Empty:

Application Form

Character References

Professional Reference

Education Record

Armed Services Record

Self Employed or Company Director

Employment Record

Declaration

Diversity Data Capture