Version 1.6 Employment Application Form Job Code Ref (NI only): Position Applied For: 1 Title * 2 Forename * 3 Middle (s) 4 Surname * 5 Known As 6a NI Number *UK only 6b PPS *ROI only 7 Date of Birth *dd-mon-yy Instructions: Please contact Employee Shared Services (ESS) with any questions about the form prior to submission. 1 This form must be completed fully for all job applications 2 Complete all sections on the form as instructed 3 Please complete this form electronically using the following for guidance: a. Use the drop down selections to complete your answer where applicable b. Mark all other boxes with an X where appropriate or as instructed c. Save the file using Date of Birth_Surname_ First name for the file name (e.g. 120667_Smith_Jane) d. Submit your completed application to the e-mail address detailed in the Job Advertisment 4 Once completed please send to ESS via Service w Section A1: Personal Details Ensure that all mandatory fields marked * are completed. 1 Home * Town County Post Code * Country 2 Phone * Preferred Contact Number (please enter ' before number) 3 Home E-Mail (used for offer letter etc.) 4 Gender * 5 Marital Status * Go to Section A2 Section A2: Next Of Kin 1 First Point Of Contact in the case of an emergency: a Full b c Effective Date d Town County Post Code Country Phone. Page 1 of 7 Go to Section B
Section B: Additional Information 1 Do you hold a full Driving Licence? If, proceed to Question 2 2 If : Country of Issue Licence Number Expiry Date Details: 3 Are you a member of any professional body? If, proceed to Question 4 If, provide details and level of membership 4 Have you any unspent criminal convictions as defined in the Rehabilitation of Offenders Act 1974(UK) or the Rehabilitation of Offenders Order 1978 (rthern Ireland)? (If yes, please give details at the end of form.) If your offence is spent, you do not need to declare this offence on this form. Go to Section C Please mark your answer with an X and provide information as applicable 1 Do you hold a FLT Licence? 2 Do you have any current licence endorsements? Section C: Driving Licences To be completed only if you are a professional driver. If yes: Licence Number Valid From Date Expiry Date Licence Category Do you hold a HGV Licence? If yes: Licence Number Valid From Date Expiry Date Licence Category(s) please list If, how many points? Please note: All licences listed above essential for the role for which you are applying will need to be produced at interview and copies will be taken. Go to Section D
Section D: Education & Training Schools Attended from Age Eleven rthern Ireland Only : Do not state school name; only state "Grammar" or Examinations Taken Level Grade Further Education State Full Time or Part Time Examinations Taken Qualifications Training History Course : State Full Time or Part Tme Start and Finish Dates Qualification / Skills Learnt Please continue in the space provided at the end of this application if necessary Go to Section E
Section E: Employment History & Experience Your Present Employer Current Salary tice Period Start Date Leaving Date * * if applicable Brief Outline of Main Duties & Responsibilities Previous Employment & Experience Brief Outline of Main Duties & Responsibilities Please continue in the space provided at the end of this application if necessary Supporting Information Please describe the skills, knowledge and experience you have that make you suitable for this position: Please add any other information or supporting evidence you wish to provide: Go to Section F
Section F: References Please provide at least 2 employment referees, one of whom should be your present/most recent employer, and other referees Referee Information Dates Employed: Permission to contact From / To before offer is made? Please continue in the space provided at the end of this application if necessary Data Protection Statement & Declaration The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. The personal information that you provide will be used in confidence to help us monitor our recruitment processes and, unless otherwise stated, may be held and used by Wincanton to enable us to consider you for other suitable vacancies. In the event that you do not wish us to retain your information on file for these purposes, please let us know. If you take up a position with Wincanton, the information provided will be used in the administration of your employment with Wincanton. If there is a complaint or legal challenge relevant to this recruitment process, the information collected may be disclosed to or checked with third parties or against other information held by Wincanton. Wincanton may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing the application form you agree to the processing of your sensitive personal data, (as described above), in accordance with Wincanton's registration with the Data Protection Commissioner. I declare that the information I have given in this application is complete, accurate and true. I understand that providing misleading or false information will disqualify me from appointment OR, if appointed, may result in my dismissal. In the event of being offered a position, I agree to submit to a medical examination if required and agree to references being taken up. Signed: Date: Page 5 of 7
Section B (Supplement) - Additional Information Supplementary Sheet 4 If you answered to B4 (Unspent Criminal Convictions) please provide the details here: Section D (Supplement): Education and Training Training History Start and Finish Dates Qualification / Skills Section E (Supplement): Employment & Experience Previous Employment & Experience Brief Outline of Main Duties & Responsibilities Section F (Supplement): References Please enter ' before a telephone number Referee Information Dates Employed: From / To Permission to contact before offer is made?