Application Form
SCREENING AND VETTING FORM
This form is confidential
Position Applied For
Availability
Full Time
Part Time
Title
Mr
Mrs
Miss
Ms
Surname
Forname
Date of Birth
Gender
Male
Female
Prefer not to say
Address
Mobile Number
Email
SIA Licence Number
Expiry Date
Driving Licence Number
Expiry Date
National Insurance Number
Right to work in UK
Yes
No
Write to work code(share coder from Govt.Website)
Allowed Job Hours
Any Conviction
Yes
No
Any Medical condition which may effect your shift
Yes
No
Bank Details
Account Title
Bank
Sort Code
Account Number
Have you ever been made bankrupt or insolvent satisfied or otherwise in the last 6 years?
Yes
No
If yes, give details
Are you the subject of any outstanding court judgements (CCJ) or other debts (i.e., local authority charges)?
Yes
No
If yes, give details
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Employment Details
1. Record (in case of unemployed instead of company give the details of Benefit office)
Name of Company
Address
Tel No.
Position Held
Reason of Leaving
Company Email
Company Website
From
To
Reference
Name
Contact
Email
2. Record (in case of unemployed instead of company give the details of Benefit office)
Name of Company
Address
Tel No.
Position Held
Reason of Leaving
Company Email
Company Website
From
To
Reference
Name
Contact
Email
3. Record (in case of unemployed instead of company give the details of Benefit office)
Name of Company
Address
Tel No.
Position Held
Reason of Leaving
Company Email
Company Website
From
To
Reference
Name
Contact
Email
4. Record (in case of unemployed instead of company give the details of Benefit office)
Name of Company
Address
Tel No.
Position Held
Reason of Leaving
Company Email
Company Website
From
To
Reference
Name
Contact
Email
5. Record (in case of unemployed instead of company give the details of Benefit office)
Name of Company
Address
Tel No.
Position Held
Reason of Leaving
Company Email
Company Website
From
To
Reference
Name
Contact
Email
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Education Details
Secondary Education
Qualification
Name of School
Address of School
Tel No.
Email
From
To
Further Education Record (Please indicate all courses taken and qualifications obtained)
Bachelor
Qualification
Name of College or University
Address of College or University
Tel No.
Email
From
To
Masters
Qualification
Name of College or University
Address of College or University
Tel No.
Email
From
To
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Emergency Contact Details
Name of Kin
Relationship with Kin
Address of Kin
Contact of Kin
Medical Questionnaire
The purpose of the below question is just to check your medical condition especially for night shit.
Do you have any physical or mental impairment that could be classed as a disability under the Equality Act 2010?
Yes
No
Have you ever received compensation or a disability pension?
Yes
No
Are there any medical reasons why you should not do shift work?
Yes
No
Are you able to carry out strenuous physical work including climbing stairs bending, lifting and carrying?
Yes
No
Have you ever had to give up any previous job for medical reasons?
Yes
No
Have you been off work continuously for more than a month during the last five years?
Yes
No
Is your eyesight normal (with glasses if worn)
Yes
No
Is your hearing normal?
Yes
No
Do you regularly table tablets or medicine?
Yes
No
Have you ever had any operations requiring hospital admission for 5 or more days?
Yes
No
Have you ever had any of the following?
Diabetes
Yes
No
Heart or circulatory disorder
Yes
No
Stomach or intestinal disorder
Yes
No
Any condition which causes difficulties in sleeping
Yes
No
Chronic chest disorder
Yes
No
Any medication requiring to strict a timetable
Yes
No
Have you ever had any other serious illness?
Yes
No
If yes, please give very brief details
If any of the your answer is yes for any of the above questions.Please give brief details about the medication you take
Have you consulted a doctor about your health during the past 12 months?
Yes
No
If yes, please give very brief details
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For the purpose of the Asylum and Immigration Act 1996 (as amended) it is necessary for an employer to establish that an employee is entitled to work in United Kingdom, and, if so to establish if any restrictions under the Act applies to employee. The following questions must therefore be answered by the everyone to satisfy this requirement
Nationality
BRP Number
Passport Number
Immigration Status or Visa
Visa or Work Permit Expiry Date
Place of Entry into UK
Date of Entry into UK
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Please upload the following Files in PDF or JPG format
Passport
BRP (Colour front and back)
Driving License
SIA License
National Insurance Letter/Card
Proof of Address
P45 Form
Experience Letter from the last job
Link for Share Code http://www.gov.uk/view-prove-immigration-status
Share Code
In case of student
University Letter confirming the Course
University letter confirming the term times and holidays
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Terms and Conditions
I agree to the terms and conditions
Agree
Not Agree
Signature
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