Please complete the form below and click the submit button to apply for a position with this company.
Please fill the fields below
marked with * These are required, and the form will
not be able to be sent until these areas are filled
in.
Personal
Details
Position
applied for: *
Location:
*
Source
of Application: *
Title:
*
Surname:
*
Maiden
Name
(if applicable):
Forenames:
*
Address:
*
County:
*
Postcode:
*
Phone
(private): *
Phone
(business): *
May
we call you here? *
Email:
*
Date
of Birth: *
Are
you legally eligible for employment in the
UK? *
National
Insurance No. *
Do
you have a full and
current driving license?
Do you have
use
of a private car?
Please
give details of any endorsements that
you have:
Code
Date
No
of Points
Education
Please
give details of your education:
(please provide name & address of educational
establishment, dates attended, qualifications
and grades)
Further
education, professional qualifications or training courses attended:
(please provide details of training provider,
dates and qualification/course attended)
Please
use this space to explain why you feel you
would be suitable for this position,
identifying relevant skills/abilities:
Career
History
An accurate
account of the WHOLE of your career history
is required, including periods of unemployment.
The full names and addresses of all your
previous employers (including recruitment
agencies) are required as references will be taken. If you were self-employed,
please give the name and address of the
accountant(s), if any, who dealt with your
finances, as well as the name of your company.
(Please continue using the box under Other
previous employers below if necessary).
Present/most
recent employer:
Name
and full address
of present employer:
Position
Held:
From:
To:
Type
of Business:
Please
give a brief description of your present
duties and main responsibilities:
Current / Final Salary:
Reason
for leaving:
Previous
employer:
Name
and address:
Position
Held:
From:
To:
Main
responsibilities:
Final Salary:
Reason
for leaving:
Previous
employer:
Name
and address:
Position
Held:
From:
To:
Main
responsibilities:
Final Salary:
Reason
for leaving:
Previous
employer:
Name
and address:
Position
Held:
From:
To:
Main
responsibilities:
Final Salary:
Reason
for leaving:
Other
Previous employer:
Please
record the following information in
respect of each position held in the
box below: Employers names and addresses; Positions
held; Dates positions held from and
to; Main responsibilities; Final salary in
each case; and the Reasons for leaving
each employment.
When
would you be available to commence employment?
Are
there any dates that you would be unavailable
for interview?
If Yes, give dates:
Would
you be available for training courses away
from home?
Do you
have any holidays booked?
If Yes, give dates:
Please
give details of any hobbies or out-of-work
interests that you pursue:
Medical/Disability
Please
give number of sickness absence days taken
during previous 2 years:
Please
give dates and reasons for sickness absence:
We welcome
applicants from suitable individuals regardless
of any disabilities. Please advise if you
have any special requirements in relation
to the interview or selection process:
If required,
are you prepared to undergo a medical examination
and/or complete a detailed health questionnaire?
As the
company operates a no smoking policy, please
indicate if you smoke:
Declaration
*
I declare that the information contained
in this form is to the best of my
knowledge, true and complete and acknowledge
that if it is false or misleading,
this may make any offer of employment
invalid or lead to termination of
employment.
DATA
PROTECTION ACT 1998
The information you supply on this application
form will be stored and processed by the Countrywide
plc. The Countrywide plc requires the data
for operational, managerial and associated
purposes related to your employment and processing
of your application. All information will
be subject to strict security rules and confidentiality.
*
I give my consent for Countrywide plc
to store and process the information
I have provided for the purposes as
stipulated and to make any further enquiries
considered necessary in pursuing my
application for employment or during
my continued employment within the Group.
Name:
Date:
4
February
2012
Equal
Opportunities Monitoring
The
Company is commited to ensuring that all
applicants and staff receive equal consideration
on the grounds of their suitability and
qualification in relation to recruitment,
career development, promotion, etc., irrespective
of their marital status, sex, colour, race,
religion, nationality, disability, ethnic
or national origins.
To help us ensure that this policy is working
effectively and that we maintain those records
we are legally required to keep, you are
asked to supply the following information.
This form will be filed seprately from
your personal file and will be used for
monitoring purposes only.
The information you supply on this monitoring
form will be stored and processed by the Countrywide
plc. The Countrywide plc requires the data
for monitoring purposes as detailed in the
above statement. All information will be subject
to strict security rules and confidentiality.
I give my consent
for Countrywide plc to store and monitor
the information I have provided for
the above purposes.
Name: *
Date:
4
February
2012
1.
Ethnic group - I would describe my
ethnic origin as:
Bangladeshi
Black Other
Irish
Pakistani
Black African
Chinese
Other*
White
Black Caribbean
Indian
*If
other please specify:
2. Nationality:
(as shown on passport)
3. Sex:
Female
Male
4. Marital
Status:
Married
Unmarried
5. No
of Children:
Ages:
Parental
leave taken per child
Disability
A disabled person under the Disability Discrimination
Act 1995 is anyone with a 'physical or mental
impairment which has a substantial and long
term adverse effect on his or her ability
to carry out normal day-to-day activities'.
This definition can be broken down to help
explain the meaning of disability:
Physical
impairment:
examples would be
blindness, deafness, paralysis of a leg,
heart disease and progressive conditions.
Mental
impairment:
includes a clinical
well-recognised mental illness and/or what
is commonly known as a learning disability.
Substantial:
put simply, this
means the effect of the impairment on ability
to carry out normal day-to-day activities
is more than minor or trivial.
Long
term:
12 months, or recurring,
or past long term disability.
Normal
day-to-day activity:
such as washing,
eating, catching a bus or turning on a television.
Do
you consider yourself to have a disability?
If
yes, what is the nature of your disability?
Thank you for taking the time to complete this application form. When you are sure the information is correct click on the Submit button below.
