Employment Application Form

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1 Post Applied for: Employment Application Form THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN THE STRICTEST CONFIDENCE Section 1 Personal details Title: First Names: Last Name: Address: Postcode: Home Telephone Number: Mobile Telephone Number: address: National Insurance Number: Are you eligible to work in the UK? Do you hold a Category D driving licence? If yes, Do you have any points or convictions etc? : Do you hold a Driver Digital Tachograph card? Do you hold a Driver CPC card? Do you have a current DBS/CRB disclosure? You will be required to undergo a disclosure check in order to be able to work on contracts held by the company. You are required to provide evidence of the above details at your interview by bringing with you any or all of the following: Proof of eligibility to work in the UK (Passport / Birth Certificate/NIC Number etc Driving Licence & Counterpart Current/valid CRB/DBS disclosure (if available)

2 Section 2 Rehabilitation of Offenders Act Have you ever been convicted of a criminal offence? Have you any prosecutions pending? If yes, please give details / dates of offence(s) and sentence: Do you hold a valid CRB/DBS badge? You will be required to undergo a disclosure check in order to be able to work on contracts held by the company YES Section 3 Health Number of periods of sickness absence in the last 2 years: Total number of days of sickness absence in the last 2 years: Are you registered disabled? YES If yes please provide your disability number and details: Section 4 Date Date From To Education Name of School Examinations taken and Qualifications Gained (Specify Grades)

3 Section 5 Employment Record Please list chronologically, starting with current or last employer Name and Address of Employer Date From: Date To: Job Title/Job Function/ Responsibilities: Salary and Reason for Leaving

4 Section 6 Personal Attributes Please use this section to add any further information which you feel might support your application. This might include your hobbies or recreational activity, or anything you have achieved in your pervious employment which you feel might be well regarded in this application.

5 Section 7 References Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are. (NB. References will only be taken if you commence employment with us) Reference 1 Reference 2 Name: Their Position (job title): Work Relationship: Organisation: Dates Employed: Address: Name: Their Position (job title): Work Relationship: Organisation: From: To: Dates Employed: From: To: Address: Postcode Postcode Telephone N o : Telephone N o : Section 8 Declaration I confirm that the information provided in this application is both truthful and accurate. I have omitted no facts that could affect my employment and I understand that any false or misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file. Signed: Date: A.T. Brown (Coaches) Ltd. undertakes that it will treat any personal information that you provide, or that we obtain from you, in accordance with the requirements of the Data Protection Act After initial assessment, A.T. Brown (Coaches) Ltd. may keep your details on file pending suitable opportunities that may arise in the future. Please tick if you do not wish us to hold your details.

6 Section 9 Recruitment Monitoring Form To help us ensure that our Equal Opportunities Policy is fully and fairly implemented we would appreciate you completing this section. This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained purely for monitoring purposes. It is entirely voluntary, with no requirement on you to give the information if you do not want to. Application for the post of: What is your Ethnic Group? Choose ONE to indicate your cultural background. White/European African/Afro Caribbean Asian Other Gender Male Female Disability Disability is defined as physical or mental impairment, which has a substantial and long term adverse effect on a person s ability to carry out normal day to day activities. Do you consider yourself disabled? If yes, please give details: A.T. Brown (Coaches) Ltd. is an Age Positive employer, and welcomes applications from people of all ages. There is no necessity to fill in this section, but we would appreciate your help in compiling information for our Age Positive database. Age Group Over 70 Please return to: A.T. Brown (Coaches) Ltd Fremain House, Horton Enterprise Park Hortonwood 50, Telford, TF1 7GZ