APPLICATION QUESTIONNAIRE

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1 APPLICATION QUESTIONNAIRE THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE. To apply for this post please complete this application form and attach this to an with a cover letter with the subject of: JOB APPLICATION and send to: calibre.environmental@btconnect.com or you may print and post the application form and send this to us. Our address is: Calibre Environmental Ltd, Ground Floor, Jubilee Lodge, 21 Jubilee Way, Chessington, Surrey, KT9 1TR. Post Applied for: Date: Section 1 Personal details Title: Last Name: First Names: Date of Birth: Address: Postcode: Home Telephone Number: Mobile Telephone Number:

2 address: Marital Status? Are you eligible to work in the UK? Yes No Known Commitments/holidays booked? etc: How many working days have you lost due to sickness within the last 3 years? Please Note Any Offer of Employment will be subject to Satisfactory DBS Checks: Do you hold a full UK driving licence? Yes No Any Endorsements? Have you had any motor insurance claims within the last three years? Yes No If yes please give details: Current Gross Salary/Working Hours: Salary Expectations: Section 2 Rehabilitation of Offenders Act Have you ever been convicted of a criminal offence? Yes No Have you any prosecutions pending? Yes No

3 If yes, please give details / dates of offence(s) and sentence: Section 3 Health Any known Health Problems/Disabilities which may in any way affect your employment: Are you registered disabled? Yes No If yes please provide your disability number and details: Section 4 Training and Education Date From Date To Name of College/School/ Training Establishment Examinations taken and Qualifications or Certificates Gained (Specify Grades)

4 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

5

6 Any other relevant details: (If you have undertaken any work experience or internships please include this information here.)

7 Amount of notice required to present employer: Section 6 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) If you haven t been in employment you may put down academic tutors or teachers. Reference 1 Reference 2 Name: Name: Their Position (job title): Their Position (job title): Relationship to applicant: Relationship to applicant: Organisation: Organisation: Dates Employed: From: To: Dates Employed: From: To: Address: Address: Postcode Postcode

8 Telephone N o : Telephone N o : Mobile N o : Mobile N o : How long have they known you? How long have they known you? Section 7 Suitability to the role Please describe why you feel you are the most ideal candidate for the position: Use this section to show how you meet the criteria for this post drawing on all aspects of your education, skills and experience. Please ensure that you address all criteria on the person specification.

9 Media Please state where you saw this post advertised. Calibre Environmental Ltd are an equal opportunities employer. 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. I understand that any false 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.

10 Signed: Date: Calibre Environmental Ltd undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act After initial assessment, we 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.

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