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Cannock Employment Application Form
Personal Details
Application for Employment as:
Please select...
35 cwt Van Driver
Warehouse Opperative
Clerical
National Insurance Number
Surname
*
Other Names
*
Date Of Birth
*
Telephone Number
*
Address
First Line of Address
Second Line of Address
Town
Postcode
Marital Status
*
Married
Single
Widowed
Divorced
No.of children and ages
Education
Name of School
Date
School
Examinations
Name of College
Date
College
Examinations
Driving Qualifications
Driving Licence Number
Groups Covered
Expires On
Issued By
Endorsements
HGV or PSV
Do you hold a current Digital Drivers Card
Yes
No
Digital Card Number
Licence Number
Class
Issuing Authority
Date Issued
Date of Expiry
Name of Training Body
Place of Training
Vehicles trained on
Length of Training
Details of any convictions
Other Training & Qualifications
Details of any other training or qualifications
Health
Approx. Height
Approx. Weight
State of general health
Epilepsy
*
Yes
No
Diabetes
*
Yes
No
Any other form of blackout
*
Yes
No
Would you agree to an examination by a qualified medical practitioner
*
Yes
No
Do you have an eyesight disorder
*
yes
No
If yes give details
*
Do you wear glasses
*
yes
No
Date of last sight test
*
Do you suffer from any disability/illness that could effect you in employment
*
Yes
No
If 'yes' please give details
Are you a registered Disabled Person?
*
Yes
No
If 'Yes' please state registration number:
Employment History
Dates
Name address of Employer
Job Title
Ave. Weekly Earnings
Reason for Leaving
Additionl Answer
Convictions
Details of any conviction(other than for driving), if none please state:
*
Interests Outside Employment, Memberships etc
interests / Sport / Hobbies etc
Please give information on any membership you hold that may be appropriate to this application (eg: trade union, professional institution etc
Are you currently a member of a trade union?
Yes
No
If 'Yes' which union
If 'No' are you willing to join
Yes
No
References
Names and addresses of two referees, preferably including at least one previous employer
Name
Address
Contact Number
additional reference
Declaration
I will not be considered for employment as a driver without production of the appropriate, valid driving licences.
*
I accept
An offer of employment will be conditional upon receipt of satisfactory references.
*
I accept
I CERTIFY THAT THE FOREGOING INFORMATION IS CORRECT AND THAT ANY FALSE STATEMENT MADE HEREIN COULD RENDER ME LIABLE TO SUMMARY DISMISSAL.
*
I accept
PLEASE NOTE: YOU MUST COMPLETE THIS FORM FULLY, IN PARTICULAR YOUR DATE OF BIRTH AND NATIONAL INSURANCE NUMBER.
I accept
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