| LP Training and Apprenticeships CPCS Training & Test Centre

Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY
Home Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home Phone Number*

If you do not have an home phone / landline number please type N/A in the text box.
Mobile Phone Number*

If you do not have an mobile phone number please type N/A in the text box.
Email Address*

If you do not have an email address please type N/A in the text box.
National Insurance Number.*
Driving License*
- Yes
- No
Car Owner*
- Yes
- No
OVERALL SIZES (PPE):*
SHOE SIZE:*
Next of Kin Name*
First Last
Please provide the details of who to contact in emergencies
Next of Kin Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Leave blank if same as your home address
Next of Kin (Emergency) Phone Number
Next of Kin (Emergency) Phone Number*
Relationship to you (the worker)*

Diversity Monitoring Form
Logical Personnel Solutions Limited will treat everyone equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, colour, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a Trade Union or spent convictions.
Which ethnic group do you most identify with?*

e. g. British If you would prefer not to say please state so.
What is your religion or belief?*

e. g. Protestant If you would prefer not to say please state so.
Disability
A disabled person is defined in the Disability Discrimination Act as someone with a physical or mental impairment that has a substantial and long term impact on their ability to carry out day to day activities. This includes progressive and long term conditions from the point of diagnosis such as HIV, Multiple Sclerosis or cancer.
a) Having read the definition above, do you consider yourself to be disabled?*
b) If you answered yes, can you please indicate the day to day activities affected by your disability. (Tick as many as applicable)*
- Eyesight
- Hearing
- Speech
- Mobility
- Progressive condition
- Manual Dexterity
- Physical coordination
- Ability to learn or understand, or memory
- Ability to lift, carry or move everyday objects
If you wish, please state your disability here:

We will try to provide access, equipment or other practical support to people with disabilities.
Permission to work in the UK
Do you have immigration permission to work in the UK?*
In line with UKBA guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by [insert name of agency] for temporary work.
Declaration
I understand that the information I have provided above will be recorded and processed by HR manually and/or electronically in accordance with the Data Protection Act 1998 and the data protection principles contained therein.
Name*
First Last
Signed*
Date*
MM slash DD slash YYYY

Criminal Convictions Declaration Form
Have you ever been convicted of a criminal offence?*
- Yes
- No
Do you have a court appearance pending or have you been charged by the Police for a criminal offence?*
- Yes
- No
Do you have a court appearance pending or have you been charged by the Police for a criminal offence?
- Yes
- No
Do you have a court appearance pending or have you been charged by the Police for a criminal offence?
- Yes
- No
If you answered YES to A or B above, please supply the following details
Date Court Details Of Offence Sentence
Signature*

I CERTIFY THAT: I have read the Guidance Notes overleaf and have not withheld information that may affect my application for appointment. I understand that false information or omissions may lead to dismissal. The information supplied above may be verified by Logical. Data Protection Act 1998 I consent to the information which I have provided on this form being used by the Human Resources Managers in the decision making process which may include requesting a criminal records check for certain posts. If you are appointed to a post, this form is resealed in an envelope and filed in your personal file. If you are unsuccessful, the form will be retained in a sealed envelope, with the papers relating to the vacancy and kept for 6 months before being destroyed. For more information on the Rehabilitation of Offenders Act 1974 please follow the link.
Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

QUALIFICATIONS/CERTIFICATES/SAFETY CARDS	AWARDING BODY	ISSUE DATE	EXPIRY DATE	CAN A COPY BE PROVIDED (YES/NO)

QUALIFICATIONS/CERTIFICATES/SAFETY CARDS	AWARDING BODY	ISSUE DATE	EXPIRY DATE	CAN A COPY BE PROVIDED (YES/NO)

QUALIFICATIONS/CERTIFICATES/SAFETY CARDS	AWARDING BODY	ISSUE DATE	EXPIRY DATE	CAN A COPY BE PROVIDED (YES/NO)

START DATE	END DATE	EMPLOYER	DETAILS OF WORK UNDERTAKEN AND PROJECTS WORKED ON	CONTACT NAME, TEL NO & EMAIL

START DATE	END DATE	EMPLOYER	DETAILS OF WORK UNDERTAKEN AND PROJECTS WORKED ON	CONTACT NAME, TEL NO & EMAIL

SQEP

Step 1 of 6 – Personal Details

Qualification Decleration

Civil and Ground Worker Experience:

REFERENCES: – PLEASE PROVIDE THREE WORKING REFERENCES

NUCLEAR INDUSTRY EXPERIENCE

SQEP Health Assessment 2016

The above answers are true and correct to the best of my knowledge.

Diversity Monitoring Form

Disability

Permission to work in the UK

Declaration

Criminal Convictions Declaration Form

QUALIFICATIONS	Approximate number of years experience	CAN A COPY BE PROVIDED (YES/NO)

NVQ?	Please circle approximate number of years experience on the below:	Experience & Additional Comments

Company Name	Address	Contact and Position	EMAIL / TEL NO.

Company Name	Address	Contact and Position	EMAIL / TEL NO.

Company Name	Address	Contact and Position	EMAIL / TEL NO.

Date	Court	Details Of Offence	Sentence