Online Application Form

 
Position Applied For:
What type of work do you require?
Full Time
Part Time
Weekends Only
Why are you applying for this position?
Dates available for interview:
 
 
 
 

Personal Details

Title:
Surname:
Forename(s):
Address:
Post Code:
Home Telephone:
Mobile Telephone:
Email:
Gender:
Male
Female
Date of Birth:
 
NIC Number:
Number of Dependants:
Ages:

Next of Kin Details

Surname:
Forename(s):
Address:
Post Code:
Home Telephone:
Mobile Telephone:
Relationship with Employee:

Activities

What are your main hobbies and interests?

Other Details

Do you hold a full and valid UK driving license?
Yes
No
How do you intend to travel to work?
Have you ever been convicted of a criminal offence, or have any prosecutions pending (including driving convictions)?
Yes
No
Have you any history of drug abuse, including alcohol?
Yes
No
If you have answered yes to either question above please give full details including dates and if convictions are now 'spent'

Entitlement to work in the UK

Please note that you must produce evidence of your right to work in the UK before you can be given employment. To avoid delay you should take with you to your interview the original of a document providing such a right (e.g. Birth Certificate, P45, P60, National Insurance Card or Passport) and a photocopy of it. I certify the information given is correct and that I am entitled to work in the UK. I understand that misrepresentation, falsification or omission of factual information requested on this form may result in dismissal.

Are you legally entitled to work in the UK?
Yes
No

Education

School/College
Subjects studied
Qualification Achieved












Training & Qualifications

(Please tick any subjects you have received training or a qualification in)

Are you legally entitled to work in the UK?
Health & Safety at Work
First Aid
Basic Food Hygiene
COSHH
Manual Handling
Fire Safety
NVQ Level

Other training completed during your career that may be relevant to this role (certificates will be required to validate)

Further Training

Would you like to receive training in this job, if so in what areas?

Employment

Are you currently in employment?
Yes
No
If yes, what is your notice period?

Employment History

Name & Address of Employer
Date From
Date To
Job Description - Roles & Duties
Reason for Leaving
 
 
 
 
 
 
 
 
 
 

References

Please give details of two references, one of which should be a previous employer

Reference 1

Name:
Organisation:
Address:
Position Held:
Contact Number:

Reference 2

Name:
Organisation:
Address:
Position Held:
Contact Number:

Medical History

Please state the number of days you were absent from work through illness in the last 12 months:
If over 7 consecutive days, please give reasons:

Complete the following to the best of your knowledge and please be honest in all areas. Activ SAS Ltd does not discriminate on the grounds of disability. We will at all times strive to provide special working arrangements where necessary.

Do you have problems with any of the following?

Your Hearing?
Yes
No
Your Nose?
Yes
No
Your Throat?
Yes
No
Your Mouth?
Yes
No
Your Ears?
Yes
No
Your Skin?
Yes
No
Do you wear glass/contact lenses? (Please give details):
In the last 5 years have you visited your doctor, attended hospital for treatment or had any major operation or illness?
Yes
No
Are you or have you recently been taking any medicines, drugs or injections, prescribed or otherwise?
Yes
No
Have you ever had fits or loss of consciousness in any context?
Yes
No
If you answered yes to any of the above, please give full details:

Equal Opportunities

Activ SAS Ltd is committed to being an equal opportunities employer. We will ensure that candidates from all ethnic backgrounds and those with disabilities can complete equally for jobs. Please help us monitor the effectiveness and ensure that facilities are available where applicable by completing the details below. This information will not form part of our recruitment decision.

Do you consider yourself with a disability?
Yes
No
Are you registered as having a disability?
Yes
No
Please indicate what you regard to be your ethnic origin:
Does your religion require any special arrangements or break periods?
Yes
No

Data Protection

You understand and agree that the company is permitted to hold personal information about you as part of its personnel procedures and other business records and may use such information in the course of the company's business. You agreed that the company may disclose such information to third parties in the event that such disclosure is, in the company's view, required for the proper conduct of the company's business. This clause applies to information held, used or disclosed in any medium.

Job Offer

If you are unsuccessful with this position, are you happy for us to keep your details on file should another opportunity arise?
Yes
No
Please state where you heard about a job opportunity with Activ SAS Ltd?
Please confirm the above information by checking the checkbox:
I confirm that the information given on this form is correct and that any false information given will be treated as gross misconduct and may render me liable for dismissal. I understand that any offer of employment is subject to satisfactory references and that I will be subject to an initial 3 month probationary period. The company reserves the right to extend this probationary period if it deems necessary. I understand that in many circumstances fixed working hours cannot be guaranteed due to the nature of the trade.

Knowledge:

Essential Criteria:
Desirable Criteria:

Skills/Abilities:

Essential Criteria:
Desirable Criteria:

Experience:

Essential Criteria:
Desirable Criteria:

Qualifications:

Essential Criteria:
Desirable Criteria:

Personal Circumstances:

Essential Criteria:
Desirable Criteria:
 
All fields marked with * are mandatory