FM SECURITY SERVICES LTD. APPLICATION FOR EMPLOYMENT 1. PERSONAL INFORMATION Surname: Mr / Mrs/ Miss / Ms: All Forenames: Previous Surname (including Maiden Name): Height: Ft:Ins:
Weight: Address:
Postcode:Tel No: How long have you lived at this address?
Date of Birth:Age: Place of Birth:Nationality:
Also state dateand place of entry:Work Permit:
Marital Status: Married / Single / Divorced / Separated / Widowed Willing to Relocate:
kin Information
Name:
Address:
Relationship:Tel No:
Do you require full or part-time work?
2. SIA
Do you hold a current SIA Licence(s)? Licence Number
Have you attended the SIA Training Course? If YES did you? PASS
Do you hold a current Training Certificate? Certificate No:
3. BACKGROUND INFORMATION
National Insurance Number:
If no N.I. number, please supply proof of having applied to the D.S.S.
HAVE YOU EVER BEEN CONVICTED OR CAUTIONED FOR ANY OFFENCE? (If yes, give details)
OFFENCE
SENTENCE
Have you ever been dismissed by an employer for misconduct? (If yes, give dates and details)
Date: Detail:
Are there any prosecutions pending against you? (If yes, give dates and details)
Do you have any outstanding County Court Judgements for debt? (If yes, give dates and details)
4. DRIVING LICENCE
Do you hold a full U.K. car licence?
Licence Number
Do you own your own transport?
Do you have any motoring offences?
(If yes, give dates and details)
5. PHYSICAL RECORD (delete where applicable)
May we request medical information from your doctor if necessary? Have you had a chest X-Ray in the last two years?
Have you ever attended an Out Patients Department for longer than six weeks? If yes to any, give details: Please tick against box any under-mentioned illness from which you have suffered:
Asthma
Epilepsy
Heart Trouble
Rheumatic Complaints
Back Trouble
Fits
Hernia
Serious Skin Orders
Bronchitis
Fainting
Migraine
Tuberculosis
Diabetes
Hay Fever
Nervous Disorder
Are you currently receiving any medical treatment?
How many days (approximately) have you been absent owing to illness in the last two years?
Are you registered under The Disabled Persons (Employment) Act 1944 and 1958?
f yes, complete the following: Certificate No: Expiry Date:
6. Employment History
Employer Name and Address
From
To
Result
7. EDUCATION
Exams Passed
10. PERSONAL REFERENCES Please give the name, address and occupation of two persons who are not related to yourself and who have known you for at least 5 years and to whom references may be made.
11. BUSINESS & TRADE REFERENCES If you have been self-employed, give the name and address of two persons other than the Personal References shown above, who can confirm this e.g. Solicitor, Accountant, Companies with whom you have traded.
12. DECLARATION I understand that my employment is subject to satisfactory vetting. I authorise FM SECURITY SERVICES LTD. to carry out such enquiries as may be necessary at the Company’s discretion, into my background and employment record. *See Note below. I hereby declare that the information I have provided is current and truthful and that any false statements on this Application Form shall be considered cause for dismissal. I hereby certify that I have filled in this Application Form myself and that I have read, understood and agree to abide by the above Declaration.
Date: Signature of Applicant:
*NOTE: Your present employer will not be approached without your permission.
