TEP – APPLICATION & CONFIDENTIAL VERIFICATION FORM
1. Vacancy Details
Post applied for Graduate Arboricultural Consultant
Location
How did you hear about this vacancy?
Warrington, North West England
2. Personal Details
Title (Mr/Mrs/Miss etc.) National Insurance No.
Surname
Previous surname (if applicable)
Forename (s)
Date of birth
Address Previous address(es)
(if less than 5 years at current address)
Use continuation sheet if necessary
Postcode
Mobile Number
Telephone Number
Email address
Place of birth
Do you have the right to work in the UK?
Yes No
Role applied for
3. HCA Pre-Employment Questions
Are you a direct relative of anybody currently employed by the HCA?
(Spouse, Partner, Child, Parent, Sibling)
Are you a relative of anybody currently employed by the HCA?
(Grandparent, Aunt, Uncle, Cousin)
Yes
Yes
No
No
If yes, unfortunately we will be unable to process your application any further, under guidance given to us as part of our contract with the HCA.
The HCA will use this information to judge whether the relationship is acceptable to the HCA. Acceptance by the HCA is a prerequisite to an interview being arranged. The HCA’s decision is final.
If yes, please confirm name, role and place of work.
Do you have any other relationship with anybody currently employed by the HCA?
Yes No
The HCA will use this information to judge whether the relationship is acceptable to the HCA. Acceptance by the HCA is a prerequisite to an interview being arranged. The HCA’s decision is final.
If yes, please confirm name, role and place of work.
If you have answered yes to any of the questions above, do you consider there to be a potential conflict of interest as a result of your relationship?
Signed
Name
Date
Yes No
TEP – Application & Verification Form – HJC – May 2012

TEP – APPLICATION & CONFIDENTIAL VERIFICATION FORM
4.
Education –
TEP requires employment for educational references covering a minimum three year period
Name, address & telephone number of last school attended before full time employment or further education
From
Month/
Year
To
Month/
Year
Certificates, diplomas etc. obtained, stating grades & dates
Name, address & telephone number of college or university attended
From
Month/
Year
To
Month/
Year
Certificates, diplomas etc. obtained, stating grades & dates
Please give details of membership of any professional institutions or societies (and membership number, if known) relevant to the position applied for
5. Present or Last Employment
Please provide the full name, address & telephone number of
Company/Employment Agency
Position held Reason for leaving or wishing to leave
Current/
Last Salary
Contact name
Tel:
Email:
Dates employed: From
Month/
Year
To
Month/
Year
Please tick box if we may contact your current employer
6. Previous Employment – if present or last employment was under 3 years please provide employment details to cover this period. If unemployed, please state period of unemployment.
Full name, address & telephone number of
Company/Employment Agency
Use continuation sheet if necessary
Dates employed Position held/ leaving salary
Reason for leaving
From
Month/
Year
To
Month/
Year
Contact Name:
Tel:
Email:
Contact Name:
Tel:
Email:
TEP – Application & Verification Form – HJC – May 2012

TEP – APPLICATION & CONFIDENTIAL VERIFICATION FORM
7. Other Information
Do you hold a full valid UK driving licence?
Have you undergone a CRB check* (Basic
Disclosure) in the last 12 months?
If Yes, please give date:
Have you undergone a screening test for Drugs
& Alcohol* in the last 12 months?
If Yes, please give date:
Yes
Yes
Yes
No
No
No
* Due to client requirements, if successful in your application you will be required to complete a CRB Check (Basic Disclosure) and undertake a drugs & alcohol screening test as a condition of employment. If you have this information already, you will need to provide copies of the results to be held in your personnel file.
Supporting Statement –
Please enter a narrative of about 300 words describing your career to date, your approach to work and the particular skills and attributes you would like to bring to TEP . Please continue on a separate sheet if necessary.
TEP – Application & Verification Form – HJC – May 2012

NAME:
DATE:
TEP – APPLICATION & CONFIDENTIAL VERIFICATION FORM
Equal Opportunities –
TEP is an Investor in People. We operate an Equal Opportunities Policy and seek to ensure opportunities for everyone to work safely and maximise their abilities.
Do you consider yourself to have a disability or long-term health condition?
Could we make any special provisions to assist you in your work?
Yes
Yes
No
No
Details:
Post Interview Questions - To be completed only if successful at interview stage
Have you ever been convicted of an offence by a court?
NB – if under the Rehabilitation of Offenders Act 1974, your past conviction is regarded as spent, tick NO
Yes No
If Yes, give details of date(s) of offence(s) and sentences passed
Do you have any proceedings currently pending against you that could result in a conviction?
Yes No
If Yes, please give details of offense(s)
I confirm that the information I have provided on this form is true and complete to the best of my knowledge.
SIGNED:
TEP – Application & Verification Form – HJC – May 2012

TEP – APPLICATION & CONFIDENTIAL VERIFICATION FORM
DECLARATION OF CONSENT
I understand and agree that any offer of employment is conditional to the verification to TEP’s satisfaction, of information provided on the Candidate Verification Form. I confirm that the information I have provided on the
Candidate Verification Form is true and complete to the best of my knowledge.
CHECKS TO BE CARRIED OUT

Passport/ID & relevant visas – right to work in the UK

5 year residency check
 3 year employment check (or education check if less than 3 year’s work experience)

Professional qualifications (where required for the role)

Criminal Records Check – Basic Disclosure

Drugs & Alcohol Screening – See Pre-Employment Screening Policy
I also understand that it may be a criminal offence to attempt to obtain employment by deception and that any misrepresentation, omission of material fact or deception will be cause for immediate cancellation of consideration for employment, or dismissal if already employed.
I hereby authorise TEP to verify information presented on my Candidate Verification Form, which may include sensitive personal data for the purposes of the Data Protection Act 1998 and the obtaining of documents and/or information covered by the European Directive 95/46 and/or by applicable domestic data protection legislation.
I authorise TEP to perform reference checks of my employment, including current employment (current employers will only be checked in the event that I have accepted an offer of employment with TEP) and to contact the Department for Work and Pensions to confirm periods of unemployment (if applicable).
I understand that if an unsatisfactory reference is received from my current employer after I have accepted a role that TEP may terminate my employment.
I authorise TEP to perform a Basic Disclosure criminality check through Disclosure Scotland. I therefore give my permission for Atlantic Data to forward the Disclosure Certificate to The Environment Partnership (TEP)
Ltd, Genesis Centre, Birchwood Science Park, Warrington, Cheshire, WA3 7BH.
I agree to provide an original copy of a valid Drugs & Alcohol Test Results Certificate in compliance with
TEP’s pre-employment Drugs & Alcohol Screening requirements.
I confirm that my consent is explicit, fully informed and freely given for the purposes of the act.
SIGNED:
NAME:
DATE:
Please send the completed form together with the attached Declaration of Consent marked ‘Private &
Confidential’ to Jonathan Smith, TEP, Genesis Centre, Birchwood Science Park, Warrington, Cheshire, WA3
7BH or email a scanned copy of the completed form to recruitment@tep.uk.com
.
Please continue overleaf for our optional Equality Monitoring Questionnaire.
TEP – Application & Verification Form – HJC – May 2012

TEP – APPLICATION & CONFIDENTIAL VERIFICATION FORM
EQUAL OPPORTUNITIES MONITORING
TEP is committed to encouraging diversity, equality and respect as we believe this is good for individuals, society and our business. Our aim is that our workforce is representative of all sections of society and each colleague feels respected and able to give their best.
In order to help us towards this goal, we would like to monitor whether our job application process encourage all people to apply. To do so, we have reviewed advice for ACAS and, for TEP; we should like to monitor ethnicity of applications. The UK environmental sector is relatively under-represented in terms of ethnic minority communities and we wish to play our part in encouraging a wider diversity of talent entering the sector.
If you wish, please answer these questions along with the rest of your application form. The information you provide will be held confidentially and separately from the interview selection process. It will only be used for monitoring purposes to review the effectiveness of our policies.
A ASIAN OR ASIAN BRITISH
Bangladeshi
Indian
Pakistani
Any Other (please state)
B BLACK OR BLACK BRITISH
African
Caribbean
Any Other (please state)
C CHINESE OR OTHER ETHNIC GROUP
Chinese
Any Other (please state)
D MIXED HERITAGE
Asian and White
Black African and White
Black Caribbean and White
Any Other Mixed Background (please state)
E WHITE
British
Irish
Any Other (please state)
F PREFER NOT TO SAY
Comments ………………………………………………………………………………………………………
TEP – Application & Verification Form – HJC – May 2012