Application Form. Position applied for: Please specify what hours you wish to work by ticking one of the following: Full-Time. Part-Time.

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1 Application Form Position applied for: Please specify what hours you wish to work by ticking one of the following: Full-Time Part-Time Both About you Full Name Address Postcode Telephone Number Home: Mobile: Address Do you hold a full driving licence?

2 Are you over 18 years of age? Work Permits Do you need a work permit to undertake work in the UK? If answered yes, which visa do you hold? If answered yes, when does this visa expire? Education and training: Please list all qualifications you have achieved with your most recent first: Subject/Course (e.g. English) Level (e.g. GCSE, A-Level, NVQ, Degree) Grade Year Qualification Achieved Awarding Body (e.g. RSA, City & Guilds)

3 Training: Year School/College/University/Organisation Qualification Achieved Awarding Body Employment Current Role Description of role and Notice period

4 Past employment: Role Brief description of role and Role Brief description of role and Role Brief description of role and

5 If there are any gaps in your employment history, please give a brief explanation: How many days off due to sickness within the last 2 years? Relevant Skills and experience that you will bring to this job: Please use this page to show how your experience, skills and abilities are relevant to the post. Remember to include any experience you have gained in the community or voluntary work, as well as previous or present employment:

6 References Please give the names of two people who we can ask for a reference. If you are in, or have just completed, full time education one referee should be from your school/college. If you are in employment, one referee must be your present employer. If you are unemployed, one referee must be your last employer. References will only be taken up at the stage of a conditional job offer. Referee 1 Name Company Position Relationship Address Phone Number Address Can we contact this referee now? Referee 2 Name Company Position Relationship Address Phone Number Address Can we contact this referee now?

7 Partners or relative of Directors/Senior Managers: To ensure fairness, canvassing or failure to provide this information will result in our not considering your application. Are you related or do you have a current personal relationship with any Director or Senior Manager of The Little Lane Nursery Limited? If answered yes, please state the nature of the relationship: Rehabilitation of Offenders Act Disclosure of Previous Convictions - For posts that are exempt from the Rehabilitation of Offenders Act 1974 you must tell us about any convictions you may have, even if they are considered to be spent under this act - Any offer of employment will be subject to a criminal record check from the Disclosure and Barring Service (DBS) before we confirm the appointment. This record check will include details of cautions, reprimands or final warnings, as well as convictions. We will keep in strict confidence any information we receive from the DBS and will store it securely. A criminal record will not affect your chances for a post, unless it makes you unsuitable for appointment. In making this decision, we will consider the nature of the offence, how long ago and what age you were when it was committed, and any other relevant factors, including the Company s policies. Details of any previous convictions (you must include (a) nature of the offence, (b) date committed, (c) any other relevant factors: To assist us with our marketing, please confirm how you found out about the position: If you have a disability, please tell us about any adjustments we may need to make to assist you at interview: I can confirm that to the best of my knowledge the above information is correct. I accept that providing deliberately false information could result in my dismissal. Signed Dated

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