Application form

Position Applied for:

Ref No:

1. General

Name: Date of Birth: Tel No (home): E-mail address:

Address: Mobile:

2. Education/Qualifications obtained and those currently being pursued
(Could add additional information such as languages)

Name of Awarding Body:

Exams Taken/ Qualifications:

Grades:

3. Current Employment

Company Name:

Nature of Business:

Job Title:

Notice Period:

Date you joined:

Date you left (if appropriate):

What is your current salary?:

Please describe the Company, the section or department in which you work, and your main responsibilities. Briefly outline what you consider to be your major achievements to date, and your reasons for wishing to leave:

4. Previous Employment & Work Experience – start with the most recent

Company Name:

Job Title & Key Responsibilities:

Reason for Leaving:

5. Do you have permission to work in the UK?:

Should you be invited for interview you will be required to bring along proof of this, such as a UK passport, work permit and passport, etc. Full details will be provided in the request to attend an interview letter.

6. Reason for Application

Please state your reason for applying and give a few short examples of your experience which we think are a priority for this post, this could include relevant skills and achievements that demonstrate your suitability for the job. It will help if you can be specific about your personal involvement in a particular activity, say what happened as a result, and include any feedback you received. You may draw on experiences from your personal life, such as voluntary work or work in the home. Please continue on a separate sheet if necessary.

7. Health
Applications from disabled candidates are welcomed and the Company will make every effort to ensure a fair selection process. We guarantee to interview disabled candidates who meet the essential requirements for the post.

Are you disabled and do you wish to be considered under this scheme?

Individuals who were registered under the Disabled Persons (Employment) Act 1944 on both 12th January 1995 and 2nd December 1996 are treated as being disabled under the DDA.

The DDA states ‘a person has a disability…if he has a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities’.

The person must satisfy the four criteria in bold in the above statement to fall under, and therefore, be protected under the DDA.

Are you colour blind?

8. Do you have any special requirements to enable you to attend the interview?:

If yes please give details:

9. References

Please supply the names and addresses of two referees who we can obtain employment references from. One should be your current or most recent employer.

Name: Position: Company: Address: Telephone: E-mail address:

Please state whether we may approach these references at any time or only after an offer of employment has been made:

10. Other Information

How and where did you learn of this vacancy? Have you made an application to the Company before? If yes please give details:

11. Declaration

I declare to the best of my knowledge and belief, all particulars I have given are complete and true. I understand that any false declaration or misleading statement or a significant omission may disqualify me from employment and render me liable to dismissal. I understand that any job offer is subject to references, a probationary period and (if the Company believes it appropriate) a medical report, all of which must be deemed by the Company to be satisfactory. I 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: Date:

Data Protection Act 1998
Any data about you will be held in secure data with access restrictions. Data will also be used for employment monitoring purposes, however all data will be kept anonymous. If you are unsuccessful, your application will be destroyed after 12 months. If you are the successful candidate, relevant information will be taken from this form and used as part of your personnel record. All or parts of the information on this form may be stored manually and/or on computer files and used for the exercise of personnel or payroll administration and management information. Such use will be the subject of the provisions of the Data Protection Act 1988.

Equal Opportunities Monitoring Form

Industrial Automation & Control Ltd is an equal opportunities employer and will provide equal opportunities to all employees and job applicants and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origin, sex, marital or civil partnership status, disability, sexual orientation, religion, belief or age.

In order to enable the Company to ensure compliance with its policy, a system of monitoring has been set up. If you respond, all information will be treated as confidential and will only be used for monitoring purposes. The monitoring form does not form part of your application and will therefore be detached from it on receipt and stored separately. Once an appointment has been made, the data given on this form will be stored (on computer) in an anonymised format and the form will then be destroyed.

Position Applied for:

Ref No:

Where advertised:

Are You:

Age range:

Ethnic background

A. White
If other specify here:

B. Mixed
If other specify here:

C. Asian
If other specify here:

D. Black
If other specify here:

E. Chinese

Other ethnic group (please specify)

Prefer not to say

Disabilities: Do you consider yourself to be disabled, as defined under the Disability Discrimination Act 1995? (The DDA states “a person has a disability….. if he/she has a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities).
The person must satisfy the four criteria in bold in the above statement to fall under and therefore be protected under the DDA.

For the purposes of compliance with the Data Protection Act 1998, I hereby confirm that by completing this form I give my consent to the Company processing the data supplied on this form for the purpose of equal opportunities monitoring.