FAIR EMPLOYMENT NUMBER (Office Use Only)

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Portalon Belfast Ltd Trading as - PLEASE RETURN YOUR COMPLETED APPLICATION FORM TO: Wagamama HR, 18 Orby Link, Belfast, BT5 5HW or send by email to hr@wagamamani.com FAIR EMPLOYMENT NUMBER (Office Use Only) & Location Closing date & time DUN 1718 016 Back of House Team Member FT Dundonald 17 th October 2017 1pm OFFICE USE ONLY: Invite to interview: Yes If reason... Successful Unsuccessful Did not attend Cancelled PERSONAL DETAILS Full Name Home Address Including your postcode Contact Telephone Numbers Home Tel: Mobile Tel: (You must complete at least one contact telephone number) Email Address National Insurance Number Or if you are awaiting a National Insurance Number please tick here * You MUST complete your National Insurance (NI) number or confirm that you are awaiting your NI Number Do you require a permit/visa to work in the UK? If yes please provide us with details Yes Details: e.g. Type of Visa/ Permit / Expiry Date If you are invited for interview do you have any specific requirements in order to attend / take part in the interview process? If yes please provide us with details Yes Details: AVAILABILITY TO WORK - **THIS SECTION WILL BE USED FOR SHORTLISTING PURPOSES** In order to determine whether your current availability matches our requirements please provide details of the hours you are available to work each day over the week. If you are successfully appointed your hours and days of work will be agreed with you and scheduled in advance. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Earliest possible start time: Latest possible finish time:

Availability to work continued. Please indicate below the minimum and maximum amount of hours you can work per/week. The minimum number of hours I can work per week is The maximum number of hours I can work per week is. All contracts within Portalon Belfast Ltd are offered on a variable-hours basis. Please note that you will not be required to work all of the hours / days that you are available - adequate rest days / periods will be scheduled in line with current legislation. Education Please State Type of SCHOOL attended e.g. (Grammar, Secondary etc) Qualification(s) Obtained / Examinations undertaken Results Please state any other qualifications/ specialist training courses in hospitality / customer service / food preparation / food service / retail you have obtained: Please explain what attracts you to this type of work and give reasons of your suitability for the post (please refer to the job advertisement and include details of how you meet any essential / desirable criteria stated):

Present and Previous Work Experience: If your previous work history exceeds the space available, you may use an additional A4 page/s. Please note your name & address at the top of any additional page/s and complete the information as requested above. CV s will not be accepted If you have never been in employment before please tick this box A) Current or Last Employer tice Period B) Employment History tice Period C) Employment History tice Period

Background Please note any criminal convictions except those 'spent' under the Rehabilitation of Offenders (rthern Ireland) Order 1978. If none please state. In certain circumstances employment is dependent upon obtaining a satisfactory disclosure of criminal records. References - Please provide details of TWO referees who can provide information relating to your competency in a work environment, one of whom must be your present or most recent employer. If you are a student please give an academic referee. Address: Address: Telephone Number: Telephone Number: CHECKLIST Have you have completed all the relevant sections in full? Have you included your email address? This is often the most effective way to issue invitations to interview. Have you included at least one telephone number? Have you included details of your National Insurance Number / indicated that you are awaiting your number? Have you completed your availability to work in full? This information will be used in the short-listing process. Have you completed your Fair Employment Questionnaire and placed it in a separate sealed envelope to be returned with your application form? DECLARATION OF CONSENT ** PLEASE READ CAREFULLY ** I authorise the organisation to obtain references to support this application once an offer has been made and accepted and release the organisation and referees from any liability caused by giving and receiving information. I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal. Print Signed: Date:

Private & Confidential Fair Employment Questionnaire Fair Employment Number (Office use only) DUN 1718 016 Position Applied for Equality of Opportunity We are an equal opportunity employer. We do not discriminate on the grounds of religious belief or political opinion. 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 employees, as required by the Fair Employment Act 1989. Regardless of whether we practice our religion, most of us in rthern Ireland are seen as either Roman Catholic or Protestant. We are therefore asking you to indicate your community background & sex by ticking the appropriate box below. I am a member of the Protestant Community I am a member of the Roman Catholic Community.. I am neither a member of the Protestant or Roman Catholic Community I am a Male Applicant. I am a Female Applicant. If you do not complete this questionnaire, we are encouraged to use the residuary method, which means that we can make a determination on the basis of personal information on file. NB: It is not compulsory for you to answer the above questions. However we would stress that it is a criminal offence under the legislation for a person to give false information in connection with the preparation of a monitoring return. Please state where you viewed our advertisement: Newspaper Internet In one of our Wagamama Restaurants Any other method:. Please state the publication:. Please state website:. Please state the Restaurant location. Please state: