Position Applied For * Additional Position(s) Applied for (one position per line) Please let us know where you saw this vacancy advertised *
Surname* First Name(s)* Address* Street address Apt, Suite, Bldg. (optional) City* State / Province / Region* Postal / Zip Code* Country Home Tel number Mobile Number Date Of Birth National Insurance Number Email Address* Have you applied to Barton Grange Garden Centre before? If yes, please state when Do you require a work permit in order to work in this country? *YesNo How many days have you been absent from work due to illness in the last 2 years? Please give details of absence(s):
Please tick the appropriate box if you are a current holder of any of the following vehicle licences: Car LicenceHGV LicenceLGV LicenceFork Lift Truck Licence Please give details of any current endorsements or disqualification:
Secondary School, college University attended Please include the following information: Secondary School, college University you attended, the Date (from and to) and the Examinations Passed (please specify levels and grades), so for example: Oxford University (Sept 1995 - June 1998) GCSE Sociology (B), A Level Nuclear Physics (D) Additional Training Details / Courses Attended Please provide information of any training courses completed which are particularly relevant, including the date attended Disability Do you have a physical, mental or sensory impairment that would: affect your ability to attend an interview? YesNo affect your ability to do the job? YesNo affect your ability to complete the application form? YesNo If yes please give details:Do you believe the company could make adjustments to accommodate the above?
If you have never been in employment please skip this section
Employer Name Employer Address Street address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Country Position Held Salary Date Joined Notice Period Reason for wishing to leave:
Employer Name Dates from and to Position Held Reason for leaving
Please use this space to give us further information about your experience which may be relevant to the post (this might be voluntary work you have been involved in).
First Reference Name First Reference Address Street address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Country Second Reference Name Second Reference Address Street address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Country May we contact your present employer for a reference? *YesNo
Data Protection All information given on this form will be treated in strict confidence. If you are appointed this application will form the basis of your personal file and information may be held on computer, disclosures will only be made for employment administration and payroll purposes. If your application is unsuccessful your details will be kept for a maximum period of 12 months. If you do not wish to be considered for future vacancies please indicate here: I do not wish my application to be kept on file for future consideration Declaration By typing my name and date into the fields below, I am digitally signing this document and I confirm that all the information given in this application form is to the best of my knowledge true and accurate. I understand that any false statements or failure to disclose any information requested may result in my application being disqualified. Discovery after appointment may lead to dismissal without notice or disciplinary action. SignatureDate
