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

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

If you do not have an email address please type N/A in the text box.

Please provide the details of who to contact in emergencies

e.g. Fitter, Electrician, Industrial Operative. WARNING - Failure to provide an accurate declaration of qualifications may result in disciplinary action. All candidates must rake original certificates with them to the first day of site induction.

e. g. British If you would prefer not to say please state so.

e. g. Protestant If you would prefer not to say please state so.

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.

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.