Health Details Please answer YES or NO (Circle as appropriate)

Transcription

1 Application For Employment Please complete all sections of this form using BLOCK LETTERS. All information submitted in this application form will be treated in strict confidence. POSITION APPLIED FOR: First Name(s): Surname: Sex (M/F): Address: Home No.: Mobile No.: Date of Birth: Nationality: Place of Birth: Health Details Please answer YES or NO (Circle as appropriate) Do you smoke? Do you use glasses? If yes, do you require glasses for driving? When did you last have an eye test? Date: Have you any physical disabilities that could affect this application? Have you had any serious illness or operation? Do you have any long term disabilities or illnesses? Have you ever suffered any back injuries? Do you suffer from any back conditions? Are you on medication or any other drugs? Have you ever had an accident at work, suffered from an industrial disease or injury? Have you ever received compensation under employers liability? Please give details of any other Medical or General Health information you feel is relevant to this application: Are you willing to supply a medical cert. from your Doctor?

2 Employment History Present/Most recent Employer 1st previous employment 2nd previous employment Name and address of employer Type of business Position held Date from - to Reason for leaving Salary and hours p/week Contact name Phone number REFERENCES Please give details of two people that we may contact for a reference. They must not be relatives and must have known you for at least 2 years. (Preferably one should be your most recent employer.) Name Occupation Address Telephone No. No. of years known Have you arranged any holidays for the coming year? (If so, please give dates.) Are you willing to wear a uniform? Approximate salary required? LICENCE DETAILS AND DRIVING HISTORY Do you hold a current driving licence? If yes, country licence issued in: Do you hold a digital tachograph card? Do you hold a driver CPC Card? What category(ies) of licence do you hold? (B, D, DE, D1, D1E) If you have a D or D1 licence, when was it obtained: Do you have a SPSV Licence? If Yes, when was it issued: What is your driving licence No.: Have you ever been disqualified from driving? If yes, please give the following details: Reason Period of disqualification Date of disqualification Court Has a court ever made an order requiring the endorsement of your Driving Licence or a Provisional Driving Licence? If yes, please give the following details Reason Period of disqualification Date of disqualification Court

3 Have you ever been refused motor insurance cover? Have you ever lost your motor insurance no claims bonus? Have you ever been involved in a traffic accident(s) for which you were held responsible? Convictions Please give details of any other Motoring or Criminal Offence(s) for which you have been convicted, fined, imprisoned, conditionally discharged or placed on probation. Date Offence Type & Place of Court Sentence or Order Education School, College or Institute From To Examinations taken and results achieved Additional Training or Skills, Professional or Relevant qualifications: Date Details Please use this space to detail any hobbies, interests or useful information for this application

4 Supporting Statement - Please use this space to provide relevant information in support of your application. This may include, but is not limited to, details about driving experience, travel experience, relevant personal achievements, interests and voluntary work experience. (Continue on a separate sheet if required.)

5 ABOUT ROSE TRAVEL How did you learn about this Job that you are applying for? Why do you want to work with Rose Travel and what would you like to achieve with Rose Travel? Declaration I, the undersigned, declare: - The whole of the statements made above to be true and accurate to the best of my knowledge. - I possess all the qualifications that I claim to hold. - I am entitled to live and work in the Republic of Ireland. (Note: If you are invited to an interview and you are returning this form by , you will be asked to sign your application at the interview. If your interview is successful, you will be required to provide evidence of the above details prior to being considered for a position.) Name in Block Capitals: Signed: Date: