address. Are you over 18? Y N If no, provide date of birth D D M M Y Y Have you completed this form yourself?

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2 First, a bit about you. Please complete all mandatory fields featuring an asterisk Personal Details Title (Mr, Mrs, Miss etc.) First ame(s) Surname/Family ame Tel o. (incl. std code) address Mobile o. ational Insurance umber Are you over 18? If no, provide date of birth D D M M Have you completed this form yourself? Do you hold a valid driving licence? Do you have any endorsements If so, state endorsements and dates Emergency Contact Details Contact ame Relationship to you Tel o. (incl. std code) Mobile o. Tell us your achievements at school or college. Education & Training Please provide all qualifications from school through to college and university or any other relevant training courses.... And what you achieved after. Additional Qualifications/Memberships/Licences Please detail any qualifications or memberships to professional organisations/bodies relevant to the position you have applied for. Qualification/Membership/Reg. o. Organisation Date Awarded

3 So where are you working now? Current/Most Recent Employment Details Full name and address of employer Outline the nature of your job and your responsibilities Contact number Job Title Date from to otice period required Annual Salary/Hourly Rate Additional benefits: Why are you considering leaving/have left? What about before then? Previous Employment including Work Placements Full name and address of employer Outline the nature of your job and your responsibilities Contact number Job Title Date from to Annual Salary/Hourly Rate Reason for leaving: Full name and address of employer Outline the nature of your job and your responsibilities Contact number Job Title Date from to Annual Salary/Hourly Rate Reason for leaving: People who can tell us how good you are. Personal References ou must provide two personal referees. These should not be relatives but could be a school/college tutor or other professional person excluding your GP. ame Telephone o Profession How long have you known this person? In what capacity have you known this person? ame Telephone o Profession How long have you known this person? In what capacity have you known this person? Please note that employment references will be sought from your last employer and after acceptance of employment, also from your current employer. The company retains the right to withdraw the offer of employment or terminate the contract of employment should unacceptable references be received. Completion of this application form will be taken as your consent to apply for references.

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6 Information for us to keep... Health questionnaire incorporating working time directive 1998 Do you or have you ever suffered from any of the following: Chest problems eg, persistent cough, asthma, bronchitis, pneumonia etc Heart/Circulation problems eg. Angina, palpitationis, high blood pressure, varicons veins, vibration white finger etc Recurrent stomach problems Disability Discrimination (I) Order 2006 We welcome applications from people with disabilities. The Disability Discrimination (I) Act 1995 describes a disability as a physical or mental impairment that has a substantial and adverse long-term effect on a person s ability to carry out normal day to day activities. Having read and understood the above definition, do you have a disability? Please tick If es, do we need to make specific arrangements in order for you to attend to attend an interview? Please tick If es, detail arrangements that would assist you. Diabetes Back, neck or joint problems Eplipesy or blackouts Eye disease or poor vision Ear disease or difficulty hearing Skin disease eg. Eczema, dermatitis etc Recurring headache / migraine Any allergy including hayfever Have you had any psychiatric illness including anxiety, depression, stress etc Equal Opportunity Monitoring Brunswick Moviebowl is an equal opportunities employer. We do not discriminate on the grounds of political opinion or religious belief. We practice equality of opportunity in employment and select the best person for the job. To demonstrate our commitment to equality of opportunity in employment we need to monitor the community background of our applicants and employees, as required by the Fair Employment and Treatment (I) Order Details We are therefore asking you to complete the Monitoring Form attached to this application. Please tick the appropriate box to indicate your community background. This will be detached and filed separately on receipt of this application form. Criminal Records Have you ever been convicted of a criminal offence, been bound over or subjected to a caution? Please tick If es please give details of the type of offence, fine, sentence etc, and put in separate envelope. This will only be opened if you are considered for appointment and will be returned to you. Child and Vulnerable Adults Protection Have you ever been the subject of or are you currently aware of any allegations made against you in relation to Child and Vulnerable Adults protection? Please tick Brunswick Moviebowl undertake that it will treat any personal information (that is data from which you can be identified, such as your name, address, etc.) that you provide to us, or we obtain from you, in accordance with the Data Protection Act If you are returning this form by , you will be asked to sign it at interview. Data Protection Upon receipt of your application form, Brunswick Moviebowl will be the Data Controller of your personal data. Brunswick Moviebowl will hold all the information you have given on this application form for legal requirements and for the purposes of personnel administration and statistical analysis. our information will be held on a manual file and will also be entered in its current or altered format onto the company s computerised database. o information may be passed onto a third party unless contracted to Brunswick Moviebowl for specific employment services without your express agreement unless required by law. our signature below indicates your agreement to the above. Declaration I declare that I have read and understand all questions and parts of this application form and that all the information given by me on this form is true and correct to the best of my knowledge and belief. Signed Immigration, Asylum and ationality Act 2006 Under the Immigration, Asylum and ationality Act 2006, you are required to provide evidence of your right to work in the UK, if called for an interview you will be advised of the documents you will need to provide which will then be checked to ensure the company complies with current legislation If you have a ational Insurance number please write it here. Town of birth Country of birth Date D D M M Return Completed Application Forms to: Brunswick Moviebowl, Brunswick Lane, Pennyburn, BT48 OLU

7 Monitoring Form Fair Employment and Treatment (I) Order 1998 This form asks you to provide information from which your preferred affiliation can be determined. The following explains why this is done: We are fair employers. We do not discriminate on the grounds of religious belief, political opinion, gender, race, disability or age. We practice quality of opportunity in employment. We select the best person for the job, promotion or opportunity in employment. To do this we need to monitor the perceived religious affiliation of our employees and job applicants in accordance with the above Government Act. Therefore we are asking you to help us by indicating the community to which you belong. The information you are providing will be treated in strict confidence and protected from misuse. It will be used only by us to monitor our equality of opportunity in employment policies. Please indicate the community to which you belong by ticking the appropriate box: I am a member of the Roman Catholic community I am a member of the Protestant community I am neither a member of the Protestant or Roman Communities Male Female When you have completed this form, return it with your application. This form will be detached on receipt. Thank you for your co-operation.